EP2350305A1 - Polythérapie comportant des protéines de liaison de protéase pour des troubles inflammatoires - Google Patents

Polythérapie comportant des protéines de liaison de protéase pour des troubles inflammatoires

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Publication number
EP2350305A1
EP2350305A1 EP09822726A EP09822726A EP2350305A1 EP 2350305 A1 EP2350305 A1 EP 2350305A1 EP 09822726 A EP09822726 A EP 09822726A EP 09822726 A EP09822726 A EP 09822726A EP 2350305 A1 EP2350305 A1 EP 2350305A1
Authority
EP
European Patent Office
Prior art keywords
agent
mmp
treatment
binding protein
ala
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP09822726A
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German (de)
English (en)
Other versions
EP2350305A4 (fr
Inventor
Clive R. Wood
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Dyax Corp
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Dyax Corp
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Publication date
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Publication of EP2350305A1 publication Critical patent/EP2350305A1/fr
Publication of EP2350305A4 publication Critical patent/EP2350305A4/fr
Withdrawn legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/1703—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates
    • A61K38/1709—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
    • A61K39/39533—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals
    • A61K39/3955—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals against proteinaceous materials, e.g. enzymes, hormones, lymphokines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
    • A61P1/04—Drugs for disorders of the alimentary tract or the digestive system for ulcers, gastritis or reflux esophagitis, e.g. antacids, inhibitors of acid secretion, mucosal protectants
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A61P11/06—Antiasthmatics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A61P11/08—Bronchodilators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00—Drugs for dermatological disorders
    • A61P17/06—Antipsoriatics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P19/00—Drugs for skeletal disorders
    • A61P19/02—Drugs for skeletal disorders for joint disorders, e.g. arthritis, arthrosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K16/00—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies
    • C07K16/40—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against enzymes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/55—Fab or Fab'
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/56—Immunoglobulins specific features characterized by immunoglobulin fragments variable (Fv) region, i.e. VH and/or VL
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/56—Immunoglobulins specific features characterized by immunoglobulin fragments variable (Fv) region, i.e. VH and/or VL
    • C07K2317/565—Complementarity determining region [CDR]
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/90—Immunoglobulins specific features characterized by (pharmaco)kinetic aspects or by stability of the immunoglobulin
    • C07K2317/92—Affinity (KD), association rate (Ka), dissociation rate (Kd) or EC50 value
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2319/00—Fusion polypeptide
    • C07K2319/30—Non-immunoglobulin-derived peptide or protein having an immunoglobulin constant or Fc region, or a fragment thereof, attached thereto
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2319/00—Fusion polypeptide
    • C07K2319/32—Fusion polypeptide fusions with soluble part of a cell surface receptor, "decoy receptors"

Definitions

  • Immunosuppressive drugs inhibit or prevent activity of the immune system. They are used to: prevent the rejection of transplanted organs and tissues; treat disease (e.g., an autoimmune disease) (e.g., rheumatoid arthritis, multiple sclerosis, myasthenia gravis, systemic lupus erythematosus, Crohn's disease, pemphigus, and ulcerative colitis) and to treat some other non-autoimmune inflammatory diseases (e.g., long term allergic asthma control).
  • diseases e.g., an autoimmune disease
  • TNF ⁇ inhibitors such as REMICADE®, ENBREL®, HUMIRA® and CIMZIA®.
  • Other examples are drugs such as ORENCIA® (CTLA4-Ig (Bristol Myers Squibb)) anti-VLA4 (TYSABRI®), and anti-IL-6 receptor antibody (Chugai/Roche).
  • Inhibitors of proteases that contribute to inflammation and its consequences such as cartilage and bone erosion have the potential to arrest disease pathology and not be immunosuppressive. Thus, such protease inhibitors do not lead to infectious disease complications, and may be combined with each other as well as other drugs without undue immunosuppressive effect.
  • the disclosure provides, inter alia, methods, compositions and kits for combination therapies for treating inflammatory disorders comprising antibody, peptide and/or Kunitz domain-based protease binding proteins and immunosuppressive drugs or other therapeutic agents for inflammatory disorders.
  • Inflammatory disorders to be treated include, but are not limited to, rheumatoid arthritis, psoriasis, multiple sclerosis, systemic sclerosis, asthma, chronic obstructive pulmonary disease, inflammatory bowel disease (e.g., Crohn' s and ulcerative colitis).
  • protease binding proteins include all members of the metalloprotease family, especially targets such as MMP-14, MMP-9, MMP-12, MMP- 7 ("MMP binding proteins"), as well as other proteases such as TACE, ADAM-TS2; serine proteases, including plasmin, hepsin, matriptase, plasma kallikrein and tissue kallikrein 1 ; and cathepsins, including cathepsins B, S and K.
  • the protease binding proteins are protease inhibitors.
  • the combination therapies comprise use of an MMP binding protein (e.g., an MMP inhibitor) and a disease-modifying antirheumatic drug (DMARD) such as methotrexate, and/or a biological response modifier (BRM) such as a TNF- ⁇ inhibitor (Etanercept (ENBREL®), Adalimumab (HUMIRA®), and Infliximab (REMICADE®)), a CTLA4-Ig (Abatacept (ORENCIA®)) or an anti-CD20 (rituximab (RITUXAN®)).
  • the combination therapies may have additive and/or synergistic benefits, and increase the effect on disease symptoms and progression without increasing the risk of opportunistic infections.
  • the drug combination may allow a decrease in dose of the immunosuppressive drug or second-line agent, thereby decreasing the possibility of an adverse event (e.g., side effect).
  • compositions e.g., used in any method or kit described herein, may further comprise one or more pharmaceutically acceptable buffers, carriers, and excipients, which may provide a desirable feature to the composition including, but not limited to, enhanced administration of the composition to a patient, enhanced circulating half-life of the inhibitor, enhanced compatibility of the composition with patient blood chemistry, enhanced storage of the composition, and/or enhanced efficacy of the composition upon administration to a patient.
  • the disclosure features a method of treating an inflammatory disorder.
  • the method includes administering a therapeutically effective amount of a protease binding protein in combination with a therapeutically effective amount of a second agent, wherein the second agent is an agent for the treatment of the inflammatory disorder, to a subject having or suspected of having the inflammatory disorder.
  • the inflammatory disorder is selected from the group consisting of: rheumatoid arthritis, psoriasis, multiple sclerosis, systemic sclerosis, asthma, chronic obstructive pulmonary disease, and inflammatory bowel disease.
  • the protease binding protein is a protease inhibitor.
  • the protease binding protein binds to a protease selected from the group consisting of: plasma kallikrein, plasmin, MMP- 14, MMP-9, MMP-9/-2, and MMP- 12.
  • the protease binding protein is an inhibitor of plasma kallikrein.
  • the inhibitor of plasma kallikrein is selected from the group consisting of: a Kunitz domain containing polypeptide and aplasma kallikrein binding antibody.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that comprises the sequence:
  • XaalO is Asp or Glu
  • Xaal 1 is Asp, Gly, Ser, VaI, Asn, He, Ala or Thr
  • Xaal3 is Pro, Arg, His, Asn, Ser, Thr, Ala, Gly, Lys or Gln
  • Xaal 5 is Arg, Lys, Ala, Ser, Gly, Met, Asn or Gln
  • Xaa16 is Ala, Gly, Ser, Asp or Asn
  • Xaal 7 is Ala, Asn, Ser, He, Gly, VaI, Gln or Thr
  • Xaal 8 is His, Leu, Gln or Ala
  • Xaal9 is Pro, Gln, Leu, Asn or He
  • Xaa21 is Trp, Phe, Tyr, His or He
  • Xaa31 is Glu, Asp, Gln, Asn, Ser, Ala, VaI, Leu, He or Thr
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that comprises the sequence of amino acids 3-60 of SEQ ID NO: 2.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that consists of the sequence of amino acids 3-60 of SEQ ID NO:2.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that comprises the sequence of SEQ ID NO: 2.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that consists of the sequence of SEQ ID NO:2.
  • the protease binding protein is an inhibitor of plasmin.
  • the inhibitor of plasmin is selected from the group consisting of: a Kunitz domain containing polypeptide and a plasmin binding antibody.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that comprises the sequence:
  • Xaal, Xaa2, Xaa3, Xaa4, Xaa56, Xaa57 and Xaa58 may each individually be absent;
  • XaalO is Asp, Glu, Tyr, or Gln;
  • Xaall is Thr, Ala, Ser, VaI or Asp;
  • Xaal3 is Pro, Leu or Ala;
  • Xaal5 is Lys or Arg;
  • Xaal6 is Ala or Gly;
  • Xaal7 is Arg, Lys or Ser;
  • Xaal8 is Phe or He;
  • Xaal9 is Glu, Gln, Asp, Pro, Gly, Ser or He;
  • Xaa21 is Phe, Tyr or Trp;
  • Xaa22 is Tyr or Phe.
  • Xaa23 is Tyr or Phe;
  • Xaa31 is Asp, Glu, Thr, VaI, Gln or Ala;
  • Xaa32 is Thr, Ala, Glu, Pro, or Gln;
  • Xaa34 is VaI, He, Thr, Leu, Phe, Tyr, His, Asp, Ala, or Ser;
  • Xaa35 is Tyr or Trp;
  • Xaa36 is Gly or Ser;
  • Xaa39 is Glu, G,ly Asp, Arg, Ala, Gln, Leu, Lys, or Met;
  • Xaa40 is Gly or Ala;
  • Xaa43 is Asn or Gly; or
  • Xaa45 is Phe or Tyr; and where not specified, Xaa is any non-cysteine amino acid.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that comprises the sequence of SEQ ID NO: 100. In some embodiments, the inhibitor of plasmin is a Kunitz domain containing polypeptide that consists of the sequence of SEQ ID NO: 100.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that comprises the sequence of SEQ ID NO:200.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that consists of the sequence of SEQ ID NO:200.
  • the protease binding protein is an MMP- 14 binding protein.
  • the MMP- 14 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2400, DX-2410, M0031-C02, M0031-F01, M0033-H07, M0037-C09, M0037-D01, M0038-E06, M0038-F01, M0038-F08, M0039-H08, M0040-A06, M0040-A11, or M0043-G02.
  • the MMP- 14 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2400, DX-2410, M0031-C02, M0031-F01, M0033-H07, M0037-C09, M0037-D01, M0038-E06, M0038-F01, M0038-F08, M0039-H08, M0040-A06, M0040- Al l, or M0043-G02.
  • the MMP- 14 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2400.
  • the MMP- 14 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2400.
  • the protease binding protein is an MMP-9 binding protein.
  • the MMP-9 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2802, 539A-M0240-B03, M0078-G07, M0081-D05, M0076-D03, M0072-H07, M0075-D12, M0166-F10, M0279-A03, M0279-B02, M0288-C08, or M0281-F06.
  • the MMP-9 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2802, 539A-M0240-B03, M0078-G07, M0081-D05, M0076-D03, M0072-H07, M0075-D12, M0166-F10, M0279-A03, M0279-B02, M0288-C08, or M0281-F06.
  • the MMP-9 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2802.
  • the MMP-9 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2802.
  • the protease binding protein is an MMP-9/-2 binding protein.
  • the MMP-9/-2 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of M0237-D02, X0106-A01, X0106-B02, X0106-C04, X0106-E4, or X0106-F05.
  • the MMP-9/-2 binding protein comprises the heavy chain variable region and/or the light chain variable region of M0237-D02, X0106-A01, X0106-B02, X0106-C04, X0106-E4, or X0106-F05.
  • the MMP-9/-2 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of M0237-D02.
  • the MMP-9/-2 binding protein comprises the heavy chain variable region and/or the light chain variable region of M0237-D02.
  • the protease binding protein is an MMP- 12 binding protein.
  • the MMP- 12 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2712 (also referred to herein as DX-2712HEK), a mutant or variant of DX-2712, 539B-X0041-D02, M0134-A02, M134-A05, M134-A07, M134-A09, M134-A10, M134- AI l, M0134-B01, M134-B04, M0134-B08, M0134-B11, M0134-C01, M0134-C02, M0134-C06, M0134-C09, M0134-C10, M0134-C11, M0134-C12, M0134-D02, M0134-DO3, M0134-E04, M0134- E07, M0134-E08, M134-E11, M0134-F01, M0134-F05, M0134-G02, M0134-G
  • the MMP- 12 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2712, a mutant or variant of DX-2712, 539B-X0041-D02, M0134-A02, M134-A05, M134-A07, M134-A09, M134-A10, M134-A11, M0134-B01, M134-B04, M0134-B08, M0134-B11, M0134-C01, M0134-C02, M0134-C06, M0134-C09, M0134-C10, M0134- CI l, M0134-C12, M0134-D02, M0134-DO3, M0134-E04, M0134-E07, M0134-E08, M134-E11, M0134-F01, M0134-F05, M0134-G02, M0134-G04, M0134-G07, M0135-A03, M01
  • the MMP- 12 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2712.
  • the MMP- 12 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2712.
  • the second agent is an agent for the treatment of an inflammatory disorder selected from the group of inflammatory disorders consisting of: rheumatoid arthritis, psoriasis, multiple sclerosis, systemic sclerosis, asthma, chronic obstructive pulmonary disease, and inflammatory bowel disease.
  • the second agent is an immunosuppressant agent selected from the group consisting of: gancyclovir, etanercept, cyclosporine, tacrolimus, rapamycin, cyclophosphamide, azathioprine, mycophenolate mofetil, methotrexate, Cortisol, aldosterone, dexamethasone, a cyclooxygenase inhibitor, a 5 -lipoxygenase inhibitor, and leukotriene receptor antagonist.
  • an immunosuppressant agent selected from the group consisting of: gancyclovir, etanercept, cyclosporine, tacrolimus, rapamycin, cyclophosphamide, azathioprine, mycophenolate mofetil, methotrexate, Cortisol, aldosterone, dexamethasone, a cyclooxygenase inhibitor, a 5 -lipoxygenase inhibitor, and leukotrien
  • the second agent is an agent for the treatment of rheumatoid arthritis and comprises a nonsteroidal anti-inflammatory drug (NSAID), a corticosteroid, a Disease-Modifying Antirheumatic Drug (DMARD), or a biological response modifier (BRM).
  • NSAID nonsteroidal anti-inflammatory drug
  • DMARD Disease-Modifying Antirheumatic Drug
  • BRM biological response modifier
  • the second agent is an agent for the treatment of rheumatoid arthritis and comprises aspirin, naproxen, ibuprofen, etodolac, gold, salsalte, methotrexate, sulfasalazine, D- penicillamine, azathioprine, cyclophosphamide, chlorambucil, cyclosporine, leflunomide, etanercept, infliximab, anakinra, adalimumab, hydroxychloroquine, chloroquine phosphate, chloroquine sulphate, minocycline, or a CTLA4-Ig.
  • the second agent is an agent for the treatment of psoriasis and comprises a topical treatment or a systemic treatment.
  • the second agent is an agent for the treatment of psoriasis and comprises a topical treatment selected from the group consisting of coal tar, dithranol, a corticosteroid, a vitamin D3 analogue, and a retinoid.
  • the second agent is an agent for the treatment of psoriasis and comprises a systemic treatment selected from the group consisting of methotrexate, cyclosporine, a retinoid, tioguanine, hydroxyurea, sulfasalazine, mycophenolate mofetil, azathioprine, tacrolimus, alefacept, efalizumab, etanercept, and infliximab.
  • a systemic treatment selected from the group consisting of methotrexate, cyclosporine, a retinoid, tioguanine, hydroxyurea, sulfasalazine, mycophenolate mofetil, azathioprine, tacrolimus, alefacept, efalizumab, etanercept, and infliximab.
  • the second agent is an agent for the treatment of multiple sclerosis and comprises a corticosteroid, an interferon, glatiramer acetate, an immunosuppressant or natalizumab.
  • the second agent is an agent for the treatment of systemic sclerosis and comprises an NSAID, a calcium channel blocker, prostacyclin analogue, a dual endothelin-receptor antagonist, methotrexate, cyclosporin, an ACE inhibitor, cyclophosphamide, a steroid, or epoprostenol.
  • the second agent is an agent for the treatment of systemic sclerosis and comprises nifedipine.
  • the second agent is an agent for the treatment of systemic sclerosis and comprises iloprost.
  • the second agent is an agent for the treatment of systemic sclerosis and comprises bosentan.
  • the second agent is an agent for the treatment of asthma and comprises a glucocorticoid, a leukotriene modifier, a mast cell stabilizer, an antimuscarinic/anticholinergic, an antihistamines, an IgE blocker, or methotrexate.
  • the second agent is an agent for the treatment of asthma and comprises a beta2- adrenoceptor agonist selected from the group consisting of: salbutamol, levalbuterol, terbutaline and bitolterol.
  • the second agent is an agent for the treatment of asthma and comprises an adrenergic agonist selected from the group consisting of: inhaled epinephrine and ephedrine tablets.
  • the second agent is an agent for the treatment of asthma and comprises an antimuscarinic/anticholinergic selected from the group consisting of: ipratropium, oxitropium, and tiotropium.
  • the second agent is an agent for the treatment of asthma and comprises an inhaled glucocorticoid selected from the group consisting of: ciclesonide, beclomethasone, budesonide, flunisolide, fluticasone, mometasone, and triamcinolone.
  • the second agent is an agent for the treatment of asthma and comprises a leukotriene modifier selected from the group consisting of: montelukast, zafirlukast, pranlukast, and zileuton.
  • the second agent is an agent for the treatment of asthma and comprises a mast cell stabilizer selected from the group consisting of: cromoglicate and nedocromil.
  • the second agent is an agent for the treatment of asthma and comprises a methylxanthine selected from the group consisting of: theophylline and aminophylline.
  • the second agent is an agent for the treatment of asthma and comprises an antihistamine.
  • the second agent is an agent for the treatment of asthma and comprises an IgE blocker selected from the group consisting of: omalizumab and methotrexate.
  • the second agent is an agent for the treatment of asthma and comprises a long-acting beta 2 -adrenoceptor agonist selected from the group consisting of: salmeterol, formoterol, bambuterol, and albuterol.
  • the second agent is an agent for the treatment of asthma and comprises a combination of inhaled steroid and a long-acting bronchodilator selected from the group consisting of: fluticasone/salmeterol and budesonide/formoterol.
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a bronchodilator.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a ⁇ 2 agonist, an M 3 antimuscarinic, a leukotriene antagonist, a cromone, a corticosteroid, or a xanthine.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a ⁇ 2 agonist selected from the group consisting of: Salbutamol, Bambuterol, Clenbuterol, Fenoterol, Formoterol, and Salmeterol.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises the Ipratropium.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a cromone selected from the group consisting of: Cromoglicate and Nedocromil.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a leukotriene antagonist selected from the group consisting of: Montelukast, Pranlukast, and Zafirlukast.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a corticosteroid antagonist selected from the group consisting of: glucocorticoids, beclomethasone, mometasone, and fluticasone.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a xanthine antagonist selected from the group consisting of: theophylline, methylxanthine, and theobromine.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD) and comprises Ipratropium or Tiotropium.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of inflammatory bowel disease and comprises an immunosuppresant, an anti-TNF binding protein, a cytokine inhibitor, a BRM, or an anti-inflammatory.
  • the second agent is an agent for the treatment of inflammatory bowel disease and comprises prednisone, infliximab, azathioprine, methotrexate, 6-mercaptopurine , a mesalamine, a steroid, or CDP571 antibody.
  • the disclosure features a method of preventing an inflammatory disorder.
  • the method includes: administering a therapeutically effective amount of a protease binding protein in combination with a therapeutically effective amount of a second agent, wherein the second agent is an agent for the treatment of the inflammatory disorder, to a subject at risk of having the inflammatory disorder.
  • the inflammatory disorder is selected from the group consisting of: rheumatoid arthritis, psoriasis, multiple sclerosis, systemic sclerosis, asthma, chronic obstructive pulmonary disease, and inflammatory bowel disease.
  • the protease binding protein is a protease inhibitor.
  • the protease binding protein binds to a protease selected from the group consisting of: plasma kallikrein, plasmin, MMP- 14, MMP-9, MMP-9/-2, and MMP- 12.
  • the protease binding protein is an inhibitor of plasma kallikrein.
  • the inhibitor of plasma kallikrein is selected from the group consisting of: a Kunitz domain containing polypeptide and aplasma kallikrein binding antibody.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that comprises the sequence:
  • XaalO is Asp or Glu
  • Xaal 1 is Asp, G, l Syer, VaI, Asn, He, Ala or Thr
  • Xaal3 is Pro, Arg, His, Asn, Ser, Thr, Ala, Gly, Lys or Gln
  • Xaal 5 is Arg, Lys, Ala, Ser, , MGleyt, Asn or Gln
  • Xaa16 is Ala, Gly, Ser, Asp or Asn
  • Xaal7 is Ala, Asn, Ser, He, , G VlayI, Gln or Thr
  • Xaal8 is His, Leu, Gln or Ala
  • Xaal9 is Pro, Gln, Leu, Asn or He
  • Xaa21 is Trp, Phe, Tyr, His or He
  • Xaa31 is Glu, Asp, Gln, Asn, Ser, Ala, VaI, Leu, He or
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that comprises the sequence of amino acids 3-60 of SEQ ID NO: 2.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that consists of the sequence of amino acids 3-60 of SEQ ID NO:2.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that comprises the sequence of SEQ ID NO: 2.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that consists of the sequence of SEQ ID NO:2.
  • the protease binding protein is an inhibitor of plasmin.
  • the inhibitor of plasmin is selected from the group consisting of: a Kunitz domain containing polypeptide and a plasmin binding antibody.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that comprises the sequence:
  • Xaal, Xaa2, Xaa3, Xaa4, Xaa56, Xaa57 and Xaa58 may each individually be absent;
  • XaalO is Asp, Glu, Tyr, or Gln;
  • Xaall is Thr, Ala, Ser, VaI or Asp;
  • Xaal3 is Pro, Leu or Ala;
  • Xaal5 is Lys or Arg;
  • Xaal6 is Ala or Gly;
  • Xaal7 is Arg, Lys or Ser;
  • Xaal8 is Phe or He;
  • Xaal9 is Glu, Gln, Asp, Pro, Gly, Ser or He;
  • Xaa21 is Phe, Tyr or Trp;
  • Xaa22 is Tyr or Phe.
  • Xaa23 is Tyr or Phe;
  • Xaa31 is Asp, Glu, Thr, VaI, Gln or Ala;
  • Xaa32 is Thr, Ala, Glu, Pro, or Gln;
  • Xaa34 is VaI, He, Thr, Leu, Phe, Tyr, His, Asp, Ala, or Ser;
  • Xaa35 is Tyr or Trp;
  • Xaa36 is oGrl Syer;
  • Xaa39 is Glu, , AspG, l Ayrg, Ala, Gln, Leu, Lys, or Met;
  • Xaa40 is Gl oyr Ala;
  • Xaa43 is Asn or ;
  • G orly Xaa45 is Phe or Tyr; and where not specified, Xaa is any non-cysteine amino acid.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that comprises the sequence of SEQ ID NO: 100.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that consists of the sequence of SEQ ID NO: 100.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that comprises the sequence of SEQ ID NO:200.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that consists of the sequence of SEQ ID NO:200.
  • the protease binding protein is an MMP- 14 binding protein.
  • the MMP- 14 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2400, DX-2410, M0031-C02, M0031-F01, M0033-H07, M0037-C09, M0037-D01, M0038-E06, M0038-F01, M0038-F08, M0039-H08, M0040-A06, M0040-A11, or M0043-G02.
  • the MMP- 14 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2400, DX-2410, M0031-C02, M0031-F01, M0033-H07, M0037-C09, M0037-D01, M0038-E06, M0038-F01, M0038-F08, M0039-H08, M0040-A06, M0040- Al l, or M0043-G02.
  • the MMP- 14 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2400.
  • the MMP- 14 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2400.
  • the protease binding protein is an MMP-9 binding protein.
  • the MMP-9 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2802, 539A-M0240-B03, M0078-G07, M0081-D05, M0076-D03, M0072-H07, M0075-D12, M0166-F10, M0279-A03, M0279-B02, M0288-C08, or M0281-F06.
  • the MMP-9 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2802, 539A-M0240-B03, M0078-G07, M0081-D05, M0076-D03, M0072-H07, M0075-D12, M0166-F10, M0279-A03, M0279-B02, M0288-C08, or M0281-F06.
  • the MMP-9 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2802.
  • the MMP-9 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2802.
  • the protease binding protein is an MMP-9/-2 binding protein.
  • the MMP-9/-2 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of M0237-D02, X0106-A01, X0106-B02, X0106-C04, X0106-E4, or X0106-F05.
  • the MMP-9/-2 binding protein comprises the heavy chain variable region and/or the light chain variable region of M0237-D02, X0106-A01, X0106-B02, X0106-C04, X0106-E4, or X0106-F05.
  • the MMP-9/-2 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of M0237-D02.
  • the MMP-9/-2 binding protein comprises the heavy chain variable region and/or the light chain variable region of M0237-D02.
  • the protease binding protein is an MMP- 12 binding protein.
  • the MMP- 12 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2712, a mutant or variant of DX-2712, 539B-X0041-D02, M0134-A02, M134-A05, M134-A07, M134-A09, M134-A10, M134-A11, M0134-B01, M134-B04, M0134-B08, M0134-B11, M0134-C01, M0134-C02, M0134-C06, M0134-C09, M0134-C10, M0134-C11, M0134- C12, M0134-D02, M0134-DO3, M0134-E04, M0134-E07, M0134-E08, M134-E11, M0134-F01, M0134-F05, M0134-G02, M0134-G04, M0134-G07, M0135-A03,
  • the MMP- 12 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2712, a mutant or variant of DX-2712, 539B-X0041-D02, M0134-A02, M134-A05, M134-A07, M134-A09, M134-A10, M134-A11, M0134-B01, M134-B04, M0134-B08, M0134-B11, M0134-C01, M0134-C02, M0134-C06, M0134-C09, M0134-C10, M0134- CI l, M0134-C12, M0134-D02, M0134-DO3, M0134-E04, M0134-E07, M0134-E08, M134-E11, M0134-F01, M0134-F05, M0134-G02, M0134-G04, M0134-G07, M0135-A03, M01
  • the MMP- 12 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2712.
  • the second agent is an agent for the treatment of an inflammatory disorder selected from the group of inflammatory disorders consisting of: rheumatoid arthritis, psoriasis, multiple sclerosis, systemic sclerosis, asthma, chronic obstructive pulmonary disease, and inflammatory bowel disease.
  • the second agent is an immunosuppressant agent selected from the group consisting of: gancyclovir, etanercept, cyclosporine, tacrolimus, rapamycin, cyclophosphamide, azathioprine, mycophenolate mofetil, methotrexate, Cortisol, aldosterone, dexamethasone, a cyclooxygenase inhibitor, a 5 -lipoxygenase inhibitor, and leukotriene receptor antagonist.
  • an immunosuppressant agent selected from the group consisting of: gancyclovir, etanercept, cyclosporine, tacrolimus, rapamycin, cyclophosphamide, azathioprine, mycophenolate mofetil, methotrexate, Cortisol, aldosterone, dexamethasone, a cyclooxygenase inhibitor, a 5 -lipoxygenase inhibitor, and leukotrien
  • the second agent is an agent for the treatment of rheumatoid arthritis and comprises a nonsteroidal anti-inflammatory drug (NSAID), a corticosteroid, a Disease-Modifying Antirheumatic Drug (DMARD), or a biological response modifier (BRM).
  • NSAID nonsteroidal anti-inflammatory drug
  • DMARD Disease-Modifying Antirheumatic Drug
  • BRM biological response modifier
  • the second agent is an agent for the treatment of rheumatoid arthritis and comprises aspirin, naproxen, ibuprofen, etodolac, gold, salsalte, methotrexate, sulfasalazine, D- penicillamine, azathioprine, cyclophosphamide, chlorambucil, cyclosporine, leflunomide, etanercept, infliximab, anakinra, adalimumab, hydroxychloroquine, chloroquine phosphate, chloroquine sulphate, minocycline, or a CTLA4-Ig.
  • the second agent is an agent for the treatment of psoriasis and comprises a topical treatment or a systemic treatment.
  • the second agent is an agent for the treatment of psoriasis and comprises a topical treatment selected from the group consisting of coal tar, dithranol, a corticosteroid, a vitamin D3 analogue, and a retinoid.
  • the second agent is an agent for the treatment of psoriasis and comprises a systemic treatment selected from the group consisting of methotrexate, cyclosporine, a retinoid, tioguanine, hydroxyurea, sulfasalazine, mycophenolate mofetil, azathioprine, tacrolimus, alefacept, efalizumab, etanercept, and infliximab.
  • a systemic treatment selected from the group consisting of methotrexate, cyclosporine, a retinoid, tioguanine, hydroxyurea, sulfasalazine, mycophenolate mofetil, azathioprine, tacrolimus, alefacept, efalizumab, etanercept, and infliximab.
  • the second agent is an agent for the treatment of multiple sclerosis and comprises a corticosteroid, an interferon, glatiramer acetate, an immunosuppressant or natalizumab.
  • the second agent is an agent for the treatment of systemic sclerosis and comprises an NSAID, a calcium channel blocker, prostacyclin analogue, a dual endothelin-receptor antagonist, methotrexate, cyclosporin, an ACE inhibitor, cyclophosphamide, a steroid, or epoprostenol.
  • the second agent is an agent for the treatment of systemic sclerosis and comprises nifedipine.
  • the second agent is an agent for the treatment of systemic sclerosis and comprises iloprost.
  • the second agent is an agent for the treatment of systemic sclerosis and comprises bosentan.
  • the second agent is an agent for the treatment of asthma and comprises a glucocorticoid, a leukotriene modifier, a mast cell stabilizer, an antimuscarinic/anticholinergic, an antihistamines, an IgE blocker, or methotrexate.
  • the second agent is an agent for the treatment of asthma and comprises a beta2- adrenoceptor agonist selected from the group consisting of: salbutamol, levalbuterol, terbutaline and bitolterol.
  • the second agent is an agent for the treatment of asthma and comprises an adrenergic agonist selected from the group consisting of: inhaled epinephrine and ephedrine tablets.
  • the second agent is an agent for the treatment of asthma and comprises an antimuscarinic/anticholinergic selected from the group consisting of: ipratropium, oxitropium, and tiotropium.
  • the second agent is an agent for the treatment of asthma and comprises an inhaled glucocorticoid selected from the group consisting of: ciclesonide, beclomethasone, budesonide, flunisolide, fluticasone, mometasone, and triamcinolone.
  • the second agent is an agent for the treatment of asthma and comprises a leukotriene modifier selected from the group consisting of: montelukast, zafirlukast, pranlukast, and zileuton.
  • the second agent is an agent for the treatment of asthma and comprises a mast cell stabilizer selected from the group consisting of: cromoglicate and nedocromil.
  • the second agent is an agent for the treatment of asthma and comprises a methylxanthine selected from the group consisting of: theophylline and aminophylline. In some embodiments, the second agent is an agent for the treatment of asthma and comprises an antihistamine.
  • the second agent is an agent for the treatment of asthma and comprises an IgE blocker selected from the group consisting of: omalizumab and methotrexate.
  • the second agent is an agent for the treatment of asthma and comprises a long-acting beta 2 -adrenoceptor agonist selected from the group consisting of: salmeterol, formoterol, bambuterol, and albuterol.
  • the second agent is an agent for the treatment of asthma and comprises a combination of inhaled steroid and a long-acting bronchodilator selected from the group consisting of: fluticasone/salmeterol and budesonide/formoterol.
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a bronchodilator.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a ⁇ 2 agonist, an M 3 antimuscarinic, a leukotriene antagonist, a cromone, a corticosteroid, or a xanthine.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a ⁇ 2 agonist selected from the group consisting of: Salbutamol, Bambuterol, Clenbuterol, Fenoterol, Formoterol, and Salmeterol.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises the Ipratropium.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a cromone selected from the group consisting of: Cromoglicate and Nedocromil.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a leukotriene antagonist selected from the group consisting of: Montelukast, Pranlukast, and Zafirlukast.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a corticosteroid antagonist selected from the group consisting of: glucocorticoids, beclomethasone, mometasone, and fluticasone.
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a xanthine antagonist selected from the group consisting of: theophylline, methylxanthine, and theobromine.
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD) and comprises Ipratropium or Tiotropium.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of inflammatory bowel disease and comprises an immunosuppresant, an anti-TNF binding protein, a cytokine inhibitor, a BRM, or an anti-inflammatory.
  • the second agent is an agent for the treatment of inflammatory bowel disease and comprises prednisone, infliximab, azathioprine, methotrexate, 6-mercaptopurine , a mesalamine, a steroid, or CDP571 antibody.
  • the disclosure features a composition (e.g., an isolated composition) that includes a protease binding protein and a second agent, wherein the second agent is an agent for the treatment of an inflammatory disorder.
  • a composition e.g., an isolated composition
  • the second agent is an agent for the treatment of an inflammatory disorder.
  • the protease binding protein is a protease inhibitor.
  • the protease binding protein binds to a protease selected from the group consisting of: plasma kallikrein, plasmin, MMP- 14, MMP-9, MMP-9/-2, and MMP- 12.
  • the protease binding protein is an inhibitor of plasma kallikrein.
  • the inhibitor of plasma kallikrein is selected from the group consisting of: a Kunitz domain containing polypeptide and aplasma kallikrein binding antibody.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that comprises the sequence:
  • XaalO is Asp or Glu
  • Xaal 1 is Asp, Gly, Ser, VaI, Asn, He, Ala or Thr
  • Xaal3 is Pro, Arg, His, Asn, Ser, Thr, Ala, Gly, Lys or Gln
  • Xaal 5 is Arg, Lys, Ala, Ser, Gly, Met, Asn or Gln
  • Xaa16 is Ala, Gly, Ser, Asp or Asn
  • Xaal 7 is Ala, Asn, Ser, He, Gly, VaI, Gln or Thr
  • Xaal 8 is His, Leu, Gln or Ala
  • Xaal9 is Pro, Gln, Leu, Asn or He
  • Xaa21 is Trp, Phe, Tyr, His or He
  • Xaa31 is Glu, Asp, Gln, Asn, Ser, Ala, VaI, Leu, He or Thr
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that comprises the sequence of amino acids 3-60 of SEQ ID NO: 2.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that consists of the sequence of amino acids 3-60 of SEQ ID NO:2.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that comprises the sequence of SEQ ID NO: 2.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that consists of the sequence of SEQ ID NO:2.
  • the protease binding protein is an inhibitor of plasmin.
  • the inhibitor of plasmin is selected from the group consisting of: a Kunitz domain containing polypeptide and a plasmin binding antibody.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that comprises the sequence:
  • Xaal, Xaa2, Xaa3, Xaa4, Xaa56, Xaa57 and Xaa58 may each individually be absent;
  • XaalO is Asp, Glu, Tyr, or Gln;
  • Xaall is Thr, Ala, Ser, VaI or Asp;
  • Xaal3 is Pro, Leu or Ala;
  • Xaal5 is Lys or Arg;
  • Xaal6 is Ala or Gly;
  • Xaal7 is Arg, Lys or Ser;
  • Xaal8 is Phe or He;
  • Xaal9 is Glu, Gln, Asp, Pro, Gly, Ser or He;
  • Xaa21 is Phe, Tyr or Trp;
  • Xaa22 is Tyr or Phe.
  • Xaa23 is Tyr or Phe;
  • Xaa31 is Asp, Glu, Thr, VaI, Gln or Ala;
  • Xaa32 is Thr, Ala, Glu, Pro, or Gln;
  • Xaa34 is VaI, He, Thr, Leu, Phe, Tyr, His, Asp, Ala, or Ser;
  • Xaa35 is Tyr or Trp;
  • Xaa36 is oGrl Syer;
  • Xaa39 is Glu, , AspG, l Ayrg, Ala, Gln, Leu, Lys, or Met;
  • Xaa40 is Gl oyr Ala;
  • Xaa43 is Asn or ;
  • G orly Xaa45 is Phe or Tyr; and where not specified, Xaa is any non-cysteine amino acid.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that comprises the sequence of SEQ ID NO: 100.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that consists of the sequence of SEQ ID NO: 100.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that comprises the sequence of SEQ ID NO:200.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that consists of the sequence of SEQ ID NO:200.
  • the protease binding protein is an MMP- 14 binding protein.
  • the MMP- 14 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2400, DX-2410, M0031-C02, M0031-F01, M0033-H07, M0037-C09, M0037-D01, M0038-E06, M0038-F01, M0038-F08, M0039-H08, M0040-A06, M0040-A11, or M0043-G02.
  • the MMP- 14 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2400, DX-2410, M0031-C02, M0031-F01, M0033-H07, M0037-C09, M0037-D01, M0038-E06, M0038-F01, M0038-F08, M0039-H08, M0040-A06, M0040- Al l, or M0043-G02.
  • the MMP- 14 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2400.
  • the MMP- 14 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2400.
  • the protease binding protein is an MMP-9 binding protein.
  • the MMP-9 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2802, 539A-M0240-B03, M0078-G07, M0081-D05, M0076-D03, M0072-H07, M0075-D12, M0166-F10, M0279-A03, M0279-B02, M0288-C08, or M0281-F06.
  • the MMP-9 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2802, 539A-M0240-B03, M0078-G07, M0081-D05, M0076-D03, M0072-H07, M0075-D12, M0166-F10, M0279-A03, M0279-B02, M0288-C08, or M0281-F06.
  • the MMP-9 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2802.
  • the MMP-9 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2802.
  • the protease binding protein is an MMP-9/-2 binding protein.
  • the MMP-9/-2 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of M0237-D02, X0106-A01, X0106-B02, X0106-C04, X0106-E4, or X0106-F05.
  • the MMP-9/-2 binding protein comprises the heavy chain variable region and/or the light chain variable region of M0237-D02, X0106-A01, X0106-B02, X0106-C04, X0106-E4, or X0106-F05.
  • the MMP-9/-2 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of M0237-D02.
  • the MMP-9/-2 binding protein comprises the heavy chain variable region and/or the light chain variable region of M0237-D02.
  • the protease binding protein is an MMP- 12 binding protein.
  • the MMP- 12 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2712, a mutant or variant of DX-2712, 539B-X0041-D02, M0134-A02, M134-A05, M134-A07, M134-A09, M134-A10, M134-A11, M0134-B01, M134-B04, M0134-B08, M0134-B11, M0134-C01, M0134-C02, M0134-C06, M0134-C09, M0134-C10, M0134-C11, M0134- C12, M0134-D02, M0134-DO3, M0134-E04, M0134-E07, M0134-E08, M134-E11, M0134-F01, M0134-F05, M0134-G02, M0134-G04, M0134-G07, M0135-A03,
  • the MMP- 12 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2712, a mutant or variant of DX-2712, 539B-X0041-D02, M0134-A02, M134-A05, M134-A07, M134-A09, M134-A10, M134-A11, M0134-B01, M134-B04, M0134-B08, M0134-B11, M0134-C01, M0134-C02, M0134-C06, M0134-C09, M0134-C10, M0134- CI l, M0134-C12, M0134-D02, M0134-DO3, M0134-E04, M0134-E07, M0134-E08, M134-E11, M0134-F01, M0134-F05, M0134-G02, M0134-G04, M0134-G07, M0135-A03, M01
  • the MMP- 12 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2712. In some embodiments, the MMP- 12 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2712.
  • the second agent is an agent for the treatment of an inflammatory disorder selected from the group of inflammatory disorders consisting of: rheumatoid arthritis, psoriasis, multiple sclerosis, systemic sclerosis, asthma, chronic obstructive pulmonary disease, and inflammatory bowel disease.
  • the second agent is an immunosuppressant agent selected from the group consisting of: gancyclovir, etanercept, cyclosporine, tacrolimus, rapamycin, cyclophosphamide, azathioprine, mycophenolate mofetil, methotrexate, Cortisol, aldosterone, dexamethasone, a cyclooxygenase inhibitor, a 5 -lipoxygenase inhibitor, and leukotriene receptor antagonist.
  • an immunosuppressant agent selected from the group consisting of: gancyclovir, etanercept, cyclosporine, tacrolimus, rapamycin, cyclophosphamide, azathioprine, mycophenolate mofetil, methotrexate, Cortisol, aldosterone, dexamethasone, a cyclooxygenase inhibitor, a 5 -lipoxygenase inhibitor, and leukotrien
  • the second agent is an agent for the treatment of rheumatoid arthritis and comprises a nonsteroidal anti-inflammatory drug (NSAID), a corticosteroid, a Disease-Modifying Antirheumatic Drug (DMARD), or a biological response modifier (BRM).
  • NSAID nonsteroidal anti-inflammatory drug
  • DMARD Disease-Modifying Antirheumatic Drug
  • BRM biological response modifier
  • the second agent is an agent for the treatment of rheumatoid arthritis and comprises aspirin, naproxen, ibuprofen, etodolac, gold, salsalte, methotrexate, sulfasalazine, D- penicillamine, azathioprine, cyclophosphamide, chlorambucil, cyclosporine, leflunomide, etanercept, infliximab, anakinra, adalimumab, hydroxychloroquine, chloroquine phosphate, chloroquine sulphate, minocycline, or a CTLA4-Ig.
  • the second agent is an agent for the treatment of psoriasis and comprises a topical treatment or a systemic treatment.
  • the second agent is an agent for the treatment of psoriasis and comprises a topical treatment selected from the group consisting of coal tar, dithranol, a corticosteroid, a vitamin D3 analogue, and a retinoid.
  • the second agent is an agent for the treatment of psoriasis and comprises a systemic treatment selected from the group consisting of methotrexate, cyclosporine, a retinoid, tioguanine, hydroxyurea, sulfasalazine, mycophenolate mofetil, azathioprine, tacrolimus, alefacept, efalizumab, etanercept, and infliximab.
  • a systemic treatment selected from the group consisting of methotrexate, cyclosporine, a retinoid, tioguanine, hydroxyurea, sulfasalazine, mycophenolate mofetil, azathioprine, tacrolimus, alefacept, efalizumab, etanercept, and infliximab.
  • the second agent is an agent for the treatment of multiple sclerosis and comprises a corticosteroid, an interferon, glatiramer acetate, an immunosuppressant or natalizumab.
  • the second agent is an agent for the treatment of systemic sclerosis and comprises an NSAID, a calcium channel blocker, prostacyclin analogue, a dual endothelin-receptor antagonist, methotrexate, cyclosporin, an ACE inhibitor, cyclophosphamide, a steroid, or epoprostenol.
  • the second agent is an agent for the treatment of systemic sclerosis and comprises nifedipine.
  • the second agent is an agent for the treatment of systemic sclerosis and comprises iloprost.
  • the second agent is an agent for the treatment of systemic sclerosis and comprises bosentan.
  • the second agent is an agent for the treatment of asthma and comprises a glucocorticoid, a leukotriene modifier, a mast cell stabilizer, an antimuscarinic/anticholinergic, an antihistamines, an IgE blocker, or methotrexate.
  • the second agent is an agent for the treatment of asthma and comprises a beta2- adrenoceptor agonist selected from the group consisting of: salbutamol, levalbuterol, terbutaline and bitolterol.
  • the second agent is an agent for the treatment of asthma and comprises an adrenergic agonist selected from the group consisting of: inhaled epinephrine and ephedrine tablets.
  • the second agent is an agent for the treatment of asthma and comprises an antimuscarinic/anticholinergic selected from the group consisting of: ipratropium, oxitropium, and tiotropium.
  • the second agent is an agent for the treatment of asthma and comprises an inhaled glucocorticoid selected from the group consisting of: ciclesonide, beclomethasone, budesonide, flunisolide, fluticasone, mometasone, and triamcinolone.
  • the second agent is an agent for the treatment of asthma and comprises a leukotriene modifier selected from the group consisting of: montelukast, zafirlukast, pranlukast, and zileuton.
  • the second agent is an agent for the treatment of asthma and comprises a mast cell stabilizer selected from the group consisting of: cromoglicate and nedocromil.
  • the second agent is an agent for the treatment of asthma and comprises a methylxanthine selected from the group consisting of: theophylline and aminophylline.
  • the second agent is an agent for the treatment of asthma and comprises an antihistamine. In some embodiments, the second agent is an agent for the treatment of asthma and comprises an IgE blocker selected from the group consisting of: omalizumab and methotrexate.
  • the second agent is an agent for the treatment of asthma and comprises a long-acting beta 2 -adrenoceptor agonist selected from the group consisting of: salmeterol, formoterol, bambuterol, and albuterol.
  • the second agent is an agent for the treatment of asthma and comprises a combination of inhaled steroid and a long-acting bronchodilator selected from the group consisting of: fluticasone/salmeterol and budesonide/formoterol.
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a bronchodilator.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a ⁇ 2 agonist, an M 3 antimuscarinic, a leukotriene antagonist, a cromone, a corticosteroid, or a xanthine.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a ⁇ 2 agonist selected from the group consisting of: Salbutamol, Bambuterol, Clenbuterol, Fenoterol, Formoterol, and Salmeterol.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises the Ipratropium.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a cromone selected from the group consisting of: Cromoglicate and Nedocromil.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a leukotriene antagonist selected from the group consisting of: Montelukast, Pranlukast, and Zafirlukast.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a corticosteroid antagonist selected from the group consisting of: glucocorticoids, beclomethasone, mometasone, and fluticasone.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a xanthine antagonist selected from the group consisting of: theophylline, methylxanthine, and theobromine.
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD) and comprises Ipratropium or Tiotropium.
  • the second agent is an agent for the treatment of inflammatory bowel disease and comprises an immunosuppresant, an anti-TNF binding protein, a cytokine inhibitor, a BRM, or an anti-inflammatory.
  • the second agent is an agent for the treatment of inflammatory bowel disease and comprises prednisone, infliximab, azathioprine, methotrexate, 6-mercaptopurine , a mesalamine, a steroid, or CDP571 antibody.
  • the disclosure features a kit that contains a protease binding protein and a second agent, wherein the second agent is an agent for the treatment of an inflammatory disorder.
  • the protease binding protein is a protease inhibitor.
  • the protease binding protein binds to a protease selected from the group consisting of: plasma kallikrein, plasmin, MMP- 14, MMP-9, MMP-9/-2, and MMP- 12.
  • the protease binding protein is an inhibitor of plasma kallikrein.
  • the inhibitor of plasma kallikrein is selected from the group consisting of: a Kunitz domain containing polypeptide and aplasma kallikrein binding antibody.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that comprises the sequence:
  • XaalO is Asp or Glu
  • Xaal 1 is Asp, G, l Syer, VaI, Asn, He, Ala or Thr
  • Xaal3 is Pro, Arg, His, Asn, Ser, Thr, Ala, Gly, Lys or Gln
  • Xaal 5 is Arg, Lys, Ala, Ser, , MGleyt, Asn or Gln
  • Xaa16 is Ala, Gly, Ser, Asp or Asn
  • Xaal 7 is Ala, Asn, Ser, He, , VGalIy, Gln or Thr
  • Xaal 8 is His, Leu, Gln or Ala
  • Xaal9 is Pro, Gln, Leu, Asn or He
  • Xaa21 is Trp, Phe, Tyr, His or He
  • Xaa31 is Glu, Asp, Gln, Asn, Ser, Ala, VaI, Leu, He
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that comprises the sequence of amino acids 3-60 of SEQ ID NO: 2.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that consists of the sequence of amino acids 3-60 of SEQ ID NO:2.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that comprises the sequence of SEQ ID NO: 2.
  • the inhibitor of plasma kallikrein is a Kunitz domain containing polypeptide that consists of the sequence of SEQ ID NO:2.
  • the protease binding protein is an inhibitor of plasmin.
  • the inhibitor of plasmin is selected from the group consisting of: a Kunitz domain containing polypeptide and a plasmin binding antibody.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that comprises the sequence:
  • Xaal, Xaa2, Xaa3, Xaa4, Xaa56, Xaa57 and Xaa58 may each individually be absent;
  • XaalO is Asp, Glu, Tyr, or Gln;
  • Xaall is Thr, Ala, Ser, VaI or Asp;
  • Xaal3 is Pro, Leu or Ala;
  • Xaal5 is Lys or Arg;
  • Xaal6 is Ala or Gly;
  • Xaal7 is Arg, Lys or Ser;
  • Xaal8 is Phe or He;
  • Xaal9 is Glu, Gln, Asp, Pro, Gly, Ser or He;
  • Xaa21 is Phe, Tyr or Trp;
  • Xaa22 is Tyr or Phe.
  • Xaa23 is Tyr or Phe;
  • Xaa31 is Asp, Glu, Thr, VaI, Gln or Ala;
  • Xaa32 is Thr, Ala, Glu, Pro, or Gln;
  • Xaa34 is VaI, He, Thr, Leu, Phe, Tyr, His, Asp, Ala, or Ser;
  • Xaa35 is Tyr or Trp;
  • Xaa36 is oGrl Syer;
  • Xaa39 is Glu, , AspG, l Ayrg, Ala, Gln, Leu, Lys, or Met;
  • Xaa40 is Gl oyr Ala;
  • Xaa43 is Asn or ;
  • G orly Xaa45 is Phe or Tyr; and where not specified, Xaa is any non-cysteine amino acid.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that comprises the sequence of SEQ ID NO: 100. In some embodiments, the inhibitor of plasmin is a Kunitz domain containing polypeptide that consists of the sequence of SEQ ID NO: 100.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that comprises the sequence of SEQ ID NO:200.
  • the inhibitor of plasmin is a Kunitz domain containing polypeptide that consists of the sequence of SEQ ID NO:200.
  • the protease binding protein is an MMP- 14 binding protein.
  • the MMP- 14 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2400, DX-2410, M0031-C02, M0031-F01, M0033-H07, M0037-C09, M0037-D01, M0038-E06, M0038-F01, M0038-F08, M0039-H08, M0040-A06, M0040-A11, or M0043-G02.
  • the MMP- 14 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2400, DX-2410, M0031-C02, M0031-F01, M0033-H07, M0037-C09, M0037-D01, M0038-E06, M0038-F01, M0038-F08, M0039-H08, M0040-A06, M0040- Al l, or M0043-G02.
  • the MMP- 14 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2400.
  • the MMP- 14 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2400.
  • the protease binding protein is an MMP-9 binding protein.
  • the MMP-9 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2802, 539A-M0240-B03, M0078-G07, M0081-D05, M0076-D03, M0072-H07, M0075-D12, M0166-F10, M0279-A03, M0279-B02, M0288-C08, or M0281-F06.
  • the MMP-9 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2802, 539A-M0240-B03, M0078-G07, M0081-D05, M0076-D03, M0072-H07, M0075-D12, M0166-F10, M0279-A03, M0279-B02, M0288-C08, or M0281-F06.
  • the MMP-9 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2802.
  • the MMP-9 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2802.
  • the protease binding protein is an MMP-9/-2 binding protein.
  • the MMP-9/-2 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of M0237-D02, X0106-A01, X0106-B02, X0106-C04, X0106-E4, or X0106-F05.
  • the MMP-9/-2 binding protein comprises the heavy chain variable region and/or the light chain variable region of M0237-D02, X0106-A01, X0106-B02, X0106-C04, X0106-E4, or X0106-F05.
  • the MMP-9/-2 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of M0237-D02.
  • the MMP-9/-2 binding protein comprises the heavy chain variable region and/or the light chain variable region of M0237-D02.
  • the protease binding protein is an MMP- 12 binding protein.
  • the MMP- 12 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2712, a mutant or variant of DX-2712, 539B-X0041-D02, M0134-A02, M134-A05, M134-A07, M134-A09, M134-A10, M134-A11, M0134-B01, M134-B04, M0134-B08, M0134-B11, M0134-C01, M0134-C02, M0134-C06, M0134-C09, M0134-C10, M0134-C11, M0134- C12, M0134-D02, M0134-DO3, M0134-E04, M0134-E07, M0134-E08, M134-E11, M0134-F01, M0134-F05, M0134-G02, M0134-G04, M0134-G07, M0135-A03,
  • the MMP- 12 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2712, a mutant or variant of DX-2712, 539B-X0041-D02, M0134-A02, M134-A05, M134-A07, M134-A09, M134-A10, M134-A11, M0134-B01, M134-B04, M0134-B08, M0134-B11, M0134-C01, M0134-C02, M0134-C06, M0134-C09, M0134-C10, M0134- CI l, M0134-C12, M0134-D02, M0134-DO3, M0134-E04, M0134-E07, M0134-E08, M134-E11, M0134-F01, M0134-F05, M0134-G02, M0134-G04, M0134-G07, M0135-A03, M01
  • the MMP- 12 binding protein comprises the 3 heavy chain CDRs and/or the 3 light chain CDRs of DX-2712.
  • the MMP- 12 binding protein comprises the heavy chain variable region and/or the light chain variable region of DX-2712.
  • the second agent is an agent for the treatment of an inflammatory disorder selected from the group of inflammatory disorders consisting of: rheumatoid arthritis, psoriasis, multiple sclerosis, systemic sclerosis, asthma, chronic obstructive pulmonary disease, and inflammatory bowel disease.
  • the second agent is an immunosuppressant agent selected from the group consisting of: gancyclovir, etanercept, cyclosporine, tacrolimus, rapamycin, cyclophosphamide, azathioprine, mycophenolate mofetil, methotrexate, Cortisol, aldosterone, dexamethasone, a cyclooxygenase inhibitor, a 5 -lipoxygenase inhibitor, and leukotriene receptor antagonist.
  • an immunosuppressant agent selected from the group consisting of: gancyclovir, etanercept, cyclosporine, tacrolimus, rapamycin, cyclophosphamide, azathioprine, mycophenolate mofetil, methotrexate, Cortisol, aldosterone, dexamethasone, a cyclooxygenase inhibitor, a 5 -lipoxygenase inhibitor, and leukotrien
  • the second agent is an agent for the treatment of rheumatoid arthritis and comprises a nonsteroidal anti-inflammatory drug (NSAID), a corticosteroid, a Disease-Modifying Antirheumatic Drug (DMARD), or a biological response modifier (BRM).
  • NSAID nonsteroidal anti-inflammatory drug
  • DMARD Disease-Modifying Antirheumatic Drug
  • BRM biological response modifier
  • the second agent is an agent for the treatment of rheumatoid arthritis and comprises aspirin, naproxen, ibuprofen, etodolac, gold, salsalte, methotrexate, sulfasalazine, D- penicillamine, azathioprine, cyclophosphamide, chlorambucil, cyclosporine, leflunomide, etanercept, infliximab, anakinra, adalimumab, hydroxychloroquine, chloroquine phosphate, chloroquine sulphate, minocycline, or a CTLA4-Ig.
  • the second agent is an agent for the treatment of psoriasis and comprises a topical treatment or a systemic treatment.
  • the second agent is an agent for the treatment of psoriasis and comprises a topical treatment selected from the group consisting of coal tar, dithranol, a corticosteroid, a vitamin D3 analogue, and a retinoid.
  • the second agent is an agent for the treatment of psoriasis and comprises a systemic treatment selected from the group consisting of methotrexate, cyclosporine, a retinoid, tioguanine, hydroxyurea, sulfasalazine, mycophenolate mofetil, azathioprine, tacrolimus, alefacept, efalizumab, etanercept, and infliximab.
  • a systemic treatment selected from the group consisting of methotrexate, cyclosporine, a retinoid, tioguanine, hydroxyurea, sulfasalazine, mycophenolate mofetil, azathioprine, tacrolimus, alefacept, efalizumab, etanercept, and infliximab.
  • the second agent is an agent for the treatment of multiple sclerosis and comprises a corticosteroid, an interferon, glatiramer acetate, an immunosuppressant or natalizumab.
  • the second agent is an agent for the treatment of systemic sclerosis and comprises an NSAID, a calcium channel blocker, prostacyclin analogue, a dual endothelin-receptor antagonist, methotrexate, cyclosporin, an ACE inhibitor, cyclophosphamide, a steroid, or epoprostenol.
  • the second agent is an agent for the treatment of systemic sclerosis and comprises nifedipine. In some embodiments, the second agent is an agent for the treatment of systemic sclerosis and comprises iloprost.
  • the second agent is an agent for the treatment of systemic sclerosis and comprises bosentan.
  • the second agent is an agent for the treatment of asthma and comprises a glucocorticoid, a leukotriene modifier, a mast cell stabilizer, an antimuscarinic/anticholinergic, an antihistamines, an IgE blocker, or methotrexate.
  • the second agent is an agent for the treatment of asthma and comprises a beta2- adrenoceptor agonist selected from the group consisting of: salbutamol, levalbuterol, terbutaline and bitolterol.
  • the second agent is an agent for the treatment of asthma and comprises an adrenergic agonist selected from the group consisting of: inhaled epinephrine and ephedrine tablets.
  • the second agent is an agent for the treatment of asthma and comprises an antimuscarinic/anticholinergic selected from the group consisting of: ipratropium, oxitropium, and tiotropium.
  • the second agent is an agent for the treatment of asthma and comprises an inhaled glucocorticoid selected from the group consisting of: ciclesonide, beclomethasone, budesonide, flunisolide, fluticasone, mometasone, and triamcinolone.
  • the second agent is an agent for the treatment of asthma and comprises a leukotriene modifier selected from the group consisting of: montelukast, zafirlukast, pranlukast, and zileuton.
  • the second agent is an agent for the treatment of asthma and comprises a mast cell stabilizer selected from the group consisting of: cromoglicate and nedocromil.
  • the second agent is an agent for the treatment of asthma and comprises a methylxanthine selected from the group consisting of: theophylline and aminophylline.
  • the second agent is an agent for the treatment of asthma and comprises an antihistamine.
  • the second agent is an agent for the treatment of asthma and comprises an IgE blocker selected from the group consisting of: omalizumab and methotrexate.
  • the second agent is an agent for the treatment of asthma and comprises a long-acting beta 2 -adrenoceptor agonist selected from the group consisting of: salmeterol, formoterol, bambuterol, and albuterol.
  • the second agent is an agent for the treatment of asthma and comprises a combination of inhaled steroid and a long-acting bronchodilator selected from the group consisting of: fluticasone/salmeterol and budesonide/formoterol.
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a bronchodilator.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a ⁇ 2 agonist, an M 3 antimuscarinic, a leukotriene antagonist, a cromone, a corticosteroid, or a xanthine.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a ⁇ 2 agonist selected from the group consisting of: Salbutamol, Bambuterol, Clenbuterol, Fenoterol, Formoterol, and Salmeterol.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises the Ipratropium.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a cromone selected from the group consisting of: Cromoglicate and Nedocromil.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a leukotriene antagonist selected from the group consisting of: Montelukast, Pranlukast, and Zafirlukast.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a corticosteroid antagonist selected from the group consisting of: glucocorticoids, beclomethasone, mometasone, and fluticasone.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD)and comprises a xanthine antagonist selected from the group consisting of: theophylline, methylxanthine, and theobromine.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of chronic obstructive pulmonary disease (COPD) and comprises Ipratropium or Tiotropium.
  • COPD chronic obstructive pulmonary disease
  • the second agent is an agent for the treatment of inflammatory bowel disease and comprises an immunosuppresant, an anti-TNF binding protein, a cytokine inhibitor, a BRM, or an anti-inflammatory.
  • the second agent is an agent for the treatment of inflammatory bowel disease and comprises prednisone, infliximab, azathioprine, methotrexate, 6-mercaptopurine , a mesalamine, a steroid, or CDP571 antibody.
  • this disclosure relates to a method of treating or preventing an inflammatory disorder in a subject (e.g., a subject having or suspected of having the inflammatory disorder, or at risk thereof), the method comprising: administering an isolated protein (e.g., antibody, e.g., human antibody) (e.g., a therapeutically effective amount thereof) that binds MMP- 14 to the subject, wherein the antibody binds the same epitope or competes for binding with an antibody selected from the group consisting of DX-2400, DX-2410, M0031-C02, M0031-F01, M0033-H07, M0037-C09, M0037-D01, M0038-E06, M0038- FOl, M0038-F08, M0039-H08, M0040-A06, M0040-A11, and M0043-G02, in combination with a second agent (e.g., a therapeutically effective amount thereof), wherein the second agent is an agent for the group consisting
  • this disclosure relates to a method of treating or preventing an inflammatory disorder in a subject (e.g., a subject having or suspected of having the inflammatory disorder, or at risk thereof), the method comprising: administering an isolated protein (e.g., antibody, e.g., human antibody) (e.g., a therapeutically effective amount thereof) that binds MMP-9 to the subject, wherein the antibody binds the same epitope or competes for binding with an antibody selected from the group consisting of DX-2802, 539A-M0240-B03, M0078-G07, M0081-D05, M0076-D03, M0072-H07, M0075-D12, M0166-F10, M0279-A03, M0279-B02, M0288-C08, and M0281-F06, in combination with a second agent (e.g., a therapeutically effective amount thereof), wherein the second agent is an agent for the treatment of the inflammatory disorder.
  • an isolated protein
  • the second agent is a second agent described herein.
  • this disclosure relates to a method of treating or preventing an inflammatory disorder in a subject (e.g., a subject having or suspected of having the inflammatory disorder, or at risk thereof), the method comprising: administering an isolated protein (e.g., antibody, e.g., human antibody) (e.g., a therapeutically effective amount thereof) that binds MMP-9/-2 to the subject, wherein the antibody binds the same epitope or competes for binding with an antibody selected from the group consisting of M0237-D02, X0106-A01, X0106-B02, X0106-C04, X0106-E4, and X0106-F05, in combination with a second agent (e.g., a therapeutically effective amount thereof), wherein the second agent is an agent for the treatment of the inflammatory disorder.
  • the second agent is a second agent described herein.
  • this disclosure relates to a method of treating or preventing an inflammatory disorder in a subject (e.g., a subject having or suspected of having the inflammatory disorder, or at risk thereof), the method comprising: administering an isolated protein (e.g., antibody, e.g., human antibody) (e.g., a therapeutically effective amount thereof) that binds MMP- 12 to the subject, wherein the antibody binds the same epitope or competes for binding with an antibody selected from the group consisting of DX-2712, a mutant or variant of DX-2712, 539B-X0041-D02, M0134-A02, M134-A05, M134-A07, M134-A09, M134-A10, M134-A11, M0134-B01, M134-B04, M0134-B08, M0134-B11, M0134-C01, M0134- C02, M0134-C06, M0134-C09, M0134-C
  • FIGURE 1 depicts sequence information for DX-2712HEK.
  • FIGURE 2 depicts the effect of treatment with a negative control, DX-2712HEK and methotrexate (MTX) on disease development in a mouse model of collagen-induced arthritis, relative to a non-diseased mouse.
  • MTX methotrexate
  • FIGURE 3 depicts the effect of treatment with a negative control, DX-2712HEK and methotrexate on four key joint histological parameters in a mouse model of collagen-induced arthritis, relative to a non-diseased mouse.
  • FIGURE 4 depicts the effect of treatment with a negative control, MMP-9/2 inhibitor and methotrexate (MTX) on disease development in a mouse model of collagen-induced arthritis, relative to a non-diseased mouse.
  • MTX methotrexate
  • FIGURE 5 depicts the effect of treatment with a negative control, MMP-9/2 inhibitor and methotrexate on four key joint histological parameters in a mouse model of collagen-induced arthritis, relative to a non-diseased mouse.
  • FIGURE 6 depicts the effect of the combination of DX-2712 and methotrexate (MTX) on disease progression.
  • FIGURE 7 depicts the effect of the combination of DX-2712 and ENBREL® on disease progression.
  • FIGURE 8 depicts the effect of the combination of DX-2712 and ORENCIA® on disease progression.
  • FIGURE 9(A) depicts the effects of DX-2400 and DX-2410 in a collagen-induced arthritis (CIA) mouse model.
  • FIGURE 9(B) provides the histology score descriptions used for the results shown in FIGURE 9(A).
  • an antibody refers to a protein that includes at least one immunoglobulin variable domain or immunoglobulin variable domain sequence.
  • an antibody can include a heavy (H) chain variable region (abbreviated herein as VH), and a light (L) chain variable region (abbreviated herein as VL).
  • an antibody includes two heavy (H) chain variable regions and two light (L) chain variable regions.
  • antibody encompasses antigen-binding fragments of antibodies (e.g., single chain antibodies, Fab and sFab fragments, F(ab')2, Fd fragments, Fv fragments, scFv, and domain antibodies (dAb) fragments (de Wildt et al., Eur J Immunol.
  • An antibody can have the structural features of IgA, IgG, IgE, IgD, IgM (as well as subtypes thereof).
  • Antibodies may be from any source, but primate (human and non-human primate) and primatized are preferred.
  • VH and VL regions can be further subdivided into regions of hypervariability, termed “complementarity determining regions” ("CDR"), interspersed with regions that are more conserved, termed “framework regions” ("FR").
  • CDR complementarity determining regions
  • FR framework regions
  • the extent of the framework region and CDRs has been precisely defined (see, Kabat, E.A., et al. (1991) Sequences of Proteins of Immunological Interest, Fifth Edition, U.S. Department of Health and Human Services, N1H Publication No. 91-3242, and Chothia, C. et al. (1987) J. MoI. Biol. 196:901-917, see also www.hgmp.mrc.ac.uk). Kabat definitions are used herein.
  • Each VH and VL is typically composed of three CDRs and four FRs, arranged from amino-terminus to carboxy-terminus in the following order: FRl, CDRl, FR2,
  • the VH or VL chain of the antibody can further include all or part of a heavy or light chain constant region, to thereby form a heavy or light immunoglobulin chain, respectively.
  • the antibody is a tetramer of two heavy immunoglobulin chains and two light immunoglobulin chains, wherein the heavy and light immunoglobulin chains are inter-connected by, e.g., disulfide bonds.
  • the heavy chain constant region includes three immunoglobulin domains, CHl, CH2 and CH3.
  • the light chain constant region includes a CL domain.
  • the variable region of the heavy and light chains contains a binding domain that interacts with an antigen.
  • the constant regions of the antibodies typically mediate the binding of the antibody to host tissues or factors, including various cells of the immune system (e.g., effector cells) and the first component (CIq) of the classical complement system.
  • the light chains of the immunoglobulin may be of types kappa or lambda.
  • the antibody is glycosylated.
  • An antibody can be functional for antibody-dependent cytotoxicity and/or complement-mediated cytotoxicity.
  • One or more regions of an antibody can be human or effectively human.
  • one or more of the variable regions can be human or effectively human.
  • one or more of the CDRs can be human, e.g., HC CDRl, HC CDR2, HC CDR3, LC CDRl, LC CDR2, and LC CDR3.
  • Each of the light chain CDRs can be human.
  • HC CDR3 can be human.
  • One or more of the framework regions can be human, e.g., FRl, FR2, FR3, and FR4 of the HC or LC.
  • the Fc region can be human.
  • all the framework regions are human, e.g., derived from a human somatic cell, e.g., a hematopoietic cell that produces immunoglobulins or a non- hematopoietic cell.
  • the human sequences are germline sequences, e.g., encoded by a germline nucleic acid.
  • the framework (FR) residues of a selected Fab can be converted to the amino-acid type of the corresponding residue in the most similar primate germline gene, especially the human germline gene.
  • One or more of the constant regions can be human or effectively human.
  • At least 70, 75, 80, 85, 90, 92, 95, 98, or 100% of an immunoglobulin variable domain, the constant region, the constant domains (CHl, CH2, CH3, CLl), or the entire antibody can be human or effectively human.
  • All or part of an antibody can be encoded by an immunoglobulin gene or a segment thereof.
  • exemplary human immunoglobulin genes include the kappa, lambda, alpha (IgAl and IgA2), gamma (IgGl, IgG2, IgG3, and IgG4), delta, epsilon and mu constant region genes, as well as the many immunoglobulin variable region genes.
  • Full-length immunoglobulin "light chains" (about 25 KDa or about 214 amino acids) are encoded by a variable region gene at the NH2-terminus (about 110 amino acids) and a kappa or lambda constant region gene at the COOH- terminus.
  • Full-length immunoglobulin "heavy chains" (about 50 KDa or about 446 amino acids), are similarly encoded by a variable region gene (about 116 amino acids) and one of the other aforementioned constant region genes, e.g., gamma (encoding about 330 amino acids).
  • the length of human HC varies considerably because HC CDR3 varies from about 3 amino-acid residues to over 35 amino-acid residues.
  • antigen-binding fragment of a full length antibody refers to one or more fragments of a full-length antibody that retain the ability to specifically bind to a target of interest.
  • binding fragments encompassed within the term "antigen-binding fragment” of a full length antibody include (i) a Fab fragment, a monovalent fragment consisting of the VL, VH, CL and CHl domains; (ii) a F(ab') 2 fragment, a bivalent fragment including two Fab fragments linked by a disulfide bridge at the hinge region; (iii) a Fd fragment consisting of the VH and CHl domains; (iv) a Fv fragment consisting of the VL and VH domains of a single arm of an antibody, (v) a dAb fragment (Ward et al.
  • VL and VH are coded for by separate genes, they can be joined, using recombinant methods, by a synthetic linker that enables them to be made as a single protein chain in which the VL and VH regions pair to form monovalent molecules known as single chain Fv (scFv).
  • scFv single chain Fv
  • Antibody fragments can be obtained using any appropriate technique including conventional techniques known to those with skill in the art.
  • the term "monospecific antibody” refers to an antibody that displays a single binding specificity and affinity for a particular target, e.g., epitope.
  • This term includes a "monoclonal antibody” or “monoclonal antibody composition,” which as used herein refer to a preparation of antibodies or fragments thereof of single molecular composition, irrespective of how the antibody was generated.
  • arthritis refers to any one, subset or all of a set of inflammatory disorders involving inflammation and damage to the joints of the body. Arthritis thus includes, but is not limited to, osteoarthritis, rheumatoid arthritis, psoriatic arthritis, septic arthritis and gouty arthritis.
  • binding affinity refers to the apparent association constant or K a .
  • K a is the reciprocal of the dissociation constant (K d ).
  • a binding protein may, for example, have a binding affinity of at least 10 5 , 10 6 , 10 7 ,10 8 , 10 9 , 10 10 and 10 11 M -1 for a particular target molecule, e.g., MMP- 9, MMP-12, MMP-2, MMP-14, etc.
  • a binding affinity of at least 10 5 , 10 6 , 10 7 ,10 8 , 10 9 , 10 10 and 10 11 M -1 for a particular target molecule, e.g., MMP- 9, MMP-12, MMP-2, MMP-14, etc.
  • Higher affinity binding of a binding protein to a first target relative to a second target can be indicated by a higher K a (or a smaller numerical value K d ) for binding the first target than the K a (or numerical value K d ) for binding the second target.
  • the binding protein has specificity for the first target (e.g., a protein in a first conformation or mimic thereof) relative to the second target (e.g., the same protein in a second conformation or mimic thereof; or a second protein).
  • Differences in binding affinity can be at least 1.5, 2, 3, 4, 5, 10, 15, 20, 37.5, 50, 70, 80, 91, 100, 500, 1000, or 10 5 fold.
  • Binding affinity can be determined by a variety of methods including equilibrium dialysis, equilibrium binding, gel filtration, ELISA, surface plasmon resonance, or spectroscopy (e.g., using a fluorescence assay).
  • Exemplary conditions for evaluating binding affinity are in TRIS-buffer (5OmM TRIS, 15OmM NaCl, 5mM CaCl 2 at pH7.5). These techniques can be used to measure the concentration of bound and free binding protein as a function of binding protein (or target) concentration.
  • the concentration of bound binding protein ([Bound]) is related to the concentration of free binding protein ([Free]) and the concentration of binding sites for the binding protein on the target where (N) is the number of binding sites per target molecule by the following equation:
  • K 3 it is not always necessary to make an exact determination of K 3 , though, since sometimes it is sufficient to obtain a quantitative measurement of affinity, e.g., determined using a method such as ELISA or FACS analysis, is proportional to K 3 , and thus can be used for comparisons, such as determining whether a higher affinity is, e.g., 2-fold higher, to obtain a qualitative measurement of affinity, or to obtain an inference of affinity, e.g., by activity in a functional assay, e.g., an in vitro or in vivo assay.
  • a functional assay e.g., an in vitro or in vivo assay.
  • binding protein refers to a protein or polypeptide that can interact with a target molecule. This term is used interchangeably with "ligand.”
  • An "MMP-9 binding protein” refers to a protein that can interact with MMP-9 and includes, in particular, proteins that preferentially interact with and/or inhibit MMP-9.
  • the MMP-9 binding protein may be an antibody.
  • an "MMP-12 binding protein” refers to a protein that can interact with MMP-12 and includes, in particular, proteins that preferentially interact with and/or inhibit MMP-12.
  • MMP-9/2 binding protein refers to a protein that can interact with both MMP-9 and MMP-2 and includes, in particular, proteins that preferentially interact with and/or inhibit MMP-9 and MMP-2.
  • cognate ligand refers to a naturally occurring ligand of any of the binding proteins described herein, e.g., MMP-9, MMP-12, MMP-14 binding proteins, including naturally occurring variants thereof (e.g., splice variants, naturally occurring mutants, and isoforms).
  • combination refers to the use of the two or more agents or therapies to treat the same patient, wherein the use or action of the agents or therapies overlap in time.
  • the agents or therapies can be administered at the same time (e.g., as a single formulation that is administered to a patient or as two separate formulations administered concurrently) or sequentially in any order.
  • a “conservative amino acid substitution” is one in which the amino acid residue is replaced with an amino acid residue having a similar side chain.
  • Families of amino acid residues having similar side chains have been defined in the art. These families include amino acids with basic side chains (e.g., lysine, arginine, histidine), acidic side chains (e.g., aspartic acid, glutamic acid), uncharged polar side chains (e.g., glycine, asparagine, glutamine, serine, threonine, tyrosine, cysteine), nonpolar side chains (e.g., alanine, valine, leucine, isoleucine, proline, phenylalanine, methionine, tryptophan), beta- branched side chains (e.g., threonine, valine, isoleucine) and aromatic side chains (e.g., tyrosine, phenylalanine, tryptophan, histidine). It
  • DMARDs Disease-modifying antirheumatic drugs
  • SLE systemic lupus erythematosus
  • IDP idiopathic thrombocytopenic purpura
  • an “effectively human” immunoglobulin variable region is an immunoglobulin variable region that includes a sufficient number of human framework amino acid positions such that the immunoglobulin variable region does not elicit an immunogenic response in a normal human.
  • An “effectively human” antibody is an antibody that includes a sufficient number of human amino acid positions such that the antibody does not elicit an immunogenic response in a normal human.
  • an “epitope” refers to the site on a target compound that is bound by a binding protein (e.g., an antibody such as a Fab or full length antibody).
  • a binding protein e.g., an antibody such as a Fab or full length antibody.
  • the site can be entirely composed of amino acid components, entirely composed of chemical modifications of amino acids of the protein (e.g., glycosyl moieties), or composed of combinations thereof.
  • Overlapping epitopes include at least one common amino acid residue, glycosyl group, phosphate group, sulfate group, or other molecular feature.
  • a (first) protein e.g., antibody "binds to the same epitope” as another (second) antibody if the antibody binds to the same site on a target compound that the second antibody binds, or binds to a site that overlaps (e.g., 50%, 60%, 70%, 80%, 90%, or 100% overlap, e.g., in terms of amino acid sequence or other molecular feature (e.g., glycosyl group, phosphate group, or sulfate group) with the site that the second antibody binds.
  • overlaps e.g., 50%, 60%, 70%, 80%, 90%, or 100% overlap, e.g., in terms of amino acid sequence or other molecular feature (e.g., glycosyl group, phosphate group, or sulfate group) with the site that the second antibody binds.
  • a (first) protein e.g., antibody "competes for binding” with another (second) antibody if the binding of the first antibody to its epitope decreases (e.g., by 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, or more) the amount of the second antibody that binds to its epitope.
  • the competition can be direct (e.g., the first antibody binds to an epitope that is the same as, or overlaps with, the epitope bound by the second antibody), or indirect (e.g., the binding of the first antibody to its epitope causes a steric change in the target compound that decreases the ability of the second antibody to bind to its epitope).
  • sequence identity is calculated as follows.
  • the sequences are aligned for optimal comparison purposes (e.g., gaps can be introduced in one or both of a first and a second amino acid or nucleic acid sequence for optimal alignment and non-homologous sequences can be disregarded for comparison purposes).
  • the optimal alignment is determined as the best score using the GAP program in the GCG software package with a Blossum 62 scoring matrix with a gap penalty of 12, a gap extend penalty of 4, and a frameshift gap penalty of 5.
  • the amino acid residues or nucleotides at corresponding amino acid positions or nucleotide positions are then compared.
  • amino acid or nucleic acid “identity” is equivalent to amino acid or nucleic acid “homology”).
  • the percent identity between the two sequences is a function of the number of identical positions shared by the sequences.
  • the length of a reference sequence aligned for comparison purposes is at least 30%, preferably at least 40%, more preferably at least 50%, even more preferably at least 60%, and even more preferably at least 70%, 80%, 90%, 92%, 95%, 97%, 98%, or 100% of the length of the reference sequence.
  • the reference sequence may be the length of the immunoglobulin variable domain sequence.
  • a “humanized” immunoglobulin variable region is an immunoglobulin variable region that is modified to include a sufficient number of human framework amino acid positions such that the immunoglobulin variable region does not elicit an immunogenic response in a normal human.
  • Descriptions of "humanized” immunoglobulins include, for example, US 6,407,213 and US 5,693,762.
  • hybridizes under low stringency, medium stringency, high stringency, or very high stringency conditions describes conditions for hybridization and washing.
  • Guidance for performing hybridization reactions can be found in Current Protocols in Molecular Biology, John Wiley & Sons, N.Y. (1989), 6.3.1-6.3.6. Aqueous and nonaqueous methods are described in that reference and either can be used.
  • Specific hybridization conditions referred to herein are as follows: (1) low stringency hybridization conditions in 6X sodium chloride/sodium citrate (SSC) at about 45°C, followed by two washes in 0.2X SSC, 0.1% SDS at least at 50°C (the temperature of the washes can be increased to 55°C for low stringency conditions); (2) medium stringency hybridization conditions in 6X SSC at about 45°C, followed by one or more washes in 0.2X SSC, 0.1% SDS at 60°C; (3) high stringency hybridization conditions in 6X SSC at about 45°C, followed by one or more washes in 0.2X SSC, 0.1% SDS at 65°C; and (4) very high stringency hybridization conditions are 0.5M sodium phosphate, 7% SDS at 65 °C, followed by one or more washes at 0.2X SSC, 1% SDS at 65°C.
  • SSC sodium chloride/sodium citrate
  • Very high stringency conditions are the preferred conditions and the ones that should be used unless otherwise specified.
  • the disclosure includes nucleic acids that hybridize with low, medium, high, or very high stringency to a nucleic acid described herein or to a complement thereof, e.g., nucleic acids encoding a binding protein described herein.
  • the nucleic acids can be the same length or within 30, 20, or 10% of the length of the reference nucleic acid.
  • the nucleic acid can correspond to a region encoding an immunoglobulin variable domain sequence described herein.
  • a binding protein of interest may have mutations (e.g., at least one, two, or four, and/or less than 15, 10, 5, or 3) relative to a binding protein described herein (e.g., a conservative or non-essential amino acid substitutions), which do not have a substantial effect on protein function. Whether or not a particular substitution will be tolerated, i.e., will not adversely affect biological properties, such as binding activity can be predicted, e.g., by evaluating whether the mutation is conservative or by the method of Bowie, et al. (1990) Science 247:1306-1310.
  • an "immunoglobulin variable domain sequence” refers to an amino acid sequence which can form the structure of an immunoglobulin variable domain such that one or more CDR regions are positioned in a conformation suitable for an antigen binding site.
  • the sequence may include all or part of the amino acid sequence of a naturally-occurring variable domain.
  • the sequence may omit one, two or more N- or C-terminal amino acids, internal amino acids, may include one or more insertions or additional terminal amino acids, or may include other alterations.
  • a polypeptide that includes immunoglobulin variable domain sequence can associate with another immunoglobulin variable domain sequence to form an antigen binding site, e.g., a structure that preferentially interacts with an antigen.
  • inflammatory disorder or "inflammatory disease” includes both immune and autoimmune conditions as well as generalized conditions marked by systemic or localized inflammation.
  • the inflammatory response or condition is selected from the group consisting of asthma, alopecia greata, SLE, rheumatoid arthritis, reactive arthritis, spondylarthritis, systemic vasculitis, insulin dependent diabetes mellitus, multiple sclerosis, experimental allergic encephalomyelitis, Sjogren's syndrome, graft versus host disease, inflammatory bowel disease including Crohn's disease, ulcerative colitis, ischemia reperfusion injury, myocardial infarction, Alzheimer's disease, transplant rejection (allogeneic and xenogeneic), thermal trauma, any immune complex-induced inflammation, glomerulonephritis, myasthenia gravis, cerebral lupus, Guillain-Barre syndrome, vasculitis, systemic sclerosis, anaph
  • the inflammatory condition is not asthma, not SLE, not rheumatoid arthritis, not myasthenia gravis, not diabetes (e.g., not insulin dependent diabetes mellitus), or not transplant rejection.
  • the inflammatory condition associated with cancer i.e., malignancy
  • compositions refers to a composition that is removed from at least 90% of at least one component of a natural sample from which the isolated composition can be obtained.
  • compositions produced artificially or naturally can be "compositions of at least" a certain degree of purity if the species or population of species of interests is at least 5, 10, 25, 50, 75, 80, 90, 92, 95, 98, or 99% pure on a weight-weight basis.
  • Kanitz domain refers to a molecule comprising or containing one or more folding domains of approximately 51-64 residues that form a central anti-parallel beta sheet and a short C- terminal helix, and comprise six cysteine residues that form three disulfide bonds, resulting in a double-loop structure, or parts of such domains or any fragments, variants, modifications or derivatives thereof.
  • non-essential amino acid residue is a residue that can be altered from the wild-type sequence of the binding agent, e.g., the antibody, without abolishing or more preferably, without substantially altering a biological activity, whereas changing an "essential" amino acid residue results in a substantial loss of activity.
  • parenteral administration and “administered parenterally” as used herein means modes of administration other than enteral and topical administration, usually by injection, and includes, without limitation, intravenous, intramuscular, intraarterial, intrathecal, intracapsular, intraorbital, intracardiac, intradermal, intraperitoneal, transtracheal, subcutaneous, subcuticular, intraarticular, subcapsular, subarachnoid, intraspinal, epidural and intrasternal injection and infusion.
  • preventing refers to subjecting the subject to a pharmaceutical treatment, e.g., the administration of a drug, such that at least one symptom of the disease is prevented, that is, administered prior to clinical manifestation of the unwanted condition (e.g., disease or other unwanted state of the host animal) so that it protects the host against developing the unwanted condition.
  • a pharmaceutical treatment e.g., the administration of a drug
  • Preventing a disease may also be referred to as “prophylaxis” or “prophylactic treatment.”
  • prophylactically effective amount refers to an amount effective, at dosages and for periods of time necessary, to achieve the desired prophylactic result. Typically, because a prophylactic dose is used in subjects prior to or at an earlier stage of disease, the prophylactically effective amount will be less than the therapeutically effective amount.
  • a subject is "at risk" of having an inflammatory disorder if the subject has, for example, a genetic predisposition for the disorder, a blood relative suffering from the disorder, or another risk factor thereof.
  • a subject may be at risk of having COPD if the subject is a smoker or has been exposed to airborne irritants.
  • the term "substantially identical” is used herein to refer to a first amino acid or nucleic acid sequence that contains a sufficient number of identical or equivalent (e.g., with a similar side chain, e.g., conserved amino acid substitutions) amino acid residues or nucleotides to a second amino acid or nucleic acid sequence such that the first and second amino acid or nucleic acid sequences have (or encode proteins having) similar activities, e.g., a binding activity, a binding preference, or a biological activity.
  • the second antibody has the same specificity and has at least 50%, at least 25%, or at least 10% of the affinity relative to the same antigen.
  • sequences similar or homologous e.g., at least about 85% sequence identity
  • sequence identity can be about 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or higher.
  • substantial identity exists when the nucleic acid segments hybridize under selective hybridization conditions (e.g., highly stringent hybridization conditions), to the complement of the strand.
  • the nucleic acids may be present in whole cells, in a cell lysate, or in a partially purified or substantially pure form.
  • Motif sequences for biopolymers can include positions which can be varied amino acids.
  • the symbol "X” in such a context generally refers to any amino acid (e.g., any of the twenty natural amino acids or any of the nineteen non-cysteine amino acids).
  • Other allowed amino acids can also be indicated for example, using parentheses and slashes.
  • “(A/W/F/N/Q)" means that alanine, tryptophan, phenylalanine, asparagine, and glutamine are allowed at that particular position.
  • Statistical significance can be determined by any art known method. Exemplary statistical tests include: the Students T-test, Mann Whitney U non-parametric test, and Wilcoxon non-parametric statistical test. Some statistically significant relationships have a P value of less than 0.05 or 0.02. Particular binding proteins may show a difference, e.g., in specificity or binding that are statistically significant (e.g., P value ⁇ 0.05 or 0.02).
  • a “therapeutically effective amount” refers to an amount effective, at dosages and for periods of time necessary, to achieve the desired therapeutic result.
  • a therapeutically effective amount of the composition may vary according to factors such as the disease state, age, sex, and weight of the individual, and the ability of the protein to elicit a desired response in the individual.
  • a therapeutically effective amount is also one in which any toxic or detrimental effects of the composition is outweighed by the therapeutically beneficial effects.
  • a "therapeutically effective dosage” preferably modulates a measurable parameter, e.g., levels of circulating IgG antibodies by a statistically significant degree or at least about 20%, more preferably by at least about 40%, even more preferably by at least about 60%, and still more preferably by at least about 80% relative to untreated subjects.
  • a measurable parameter e.g., a disease-associated parameter
  • an animal model system predictive of efficacy in human disorders and conditions, e.g., an inflammatory disease (e.g., synovitis, atherosclerosis), rheumatoid arthritis or osteoarthritis.
  • this property of a composition can be evaluated by examining the ability of the compound to modulate a parameter in vitro.
  • Treating" a disease in a subject or “treating" a subject having a disease refers to subjecting the subject to a pharmaceutical treatment, e.g., the administration of a drug, such that at least one symptom of the disease is cured, alleviated or decreased.
  • the protease binding proteins and/or inhibitors may in certain embodiments be antibody, peptide or Kunitz domain-based.
  • proteases are involved in a wide variety of biological processes, including inflammation and tissue injury. Serine proteases produced by inflammatory cells, including neutrophils, are implicated in various inflammatory disorders. As such, multiple different proteases can contribute to a single disorder.
  • proteases examples include the following: plasmin, tissue kallikrein, plasma kallikrein, Factor VII a , Factor XI a , thrombin, urokinase, trypsin 1, trypsin 2, pancreatic chymotrypsin, pancreatic elastase, tryptase, and Factor II a .
  • Classes of relevant proteases include: proteases associated with blood coagulation, proteases associated with fibrinolysis, proteases associated with complement, proteases that digest extracellular matrix components, proteases that digest basement membranes, and proteases associated with endothelial cells.
  • the protease is a serine protease.
  • Putative binding proteins/inhibitors can be selected for their potency and selectivity of inhibition of the target proteases.
  • target protease and a substrate are combined under assay conditions permitting reaction of the protease with its substrate.
  • the assay is performed in the absence of the protein being tested, and in the presence of increasing concentrations of the protein being tested.
  • the concentration of test protein at which the protease activity is 50% inhibited is the IC50 value (Inhibitory Concentration) or EC50 (Effective Concentration) value for that test protein.
  • IC50 value Inhibitory Concentration
  • EC50 Effective Concentration
  • Proteins having lower IC50 or EC50 values are considered more potent inhibitors of the target protease than those proteins having higher IC50 or EC50 values.
  • Preferred proteins according to this aspect have an IC50 value of 100 nM, 10 nM, 1 nM, or 0.1 nM or less as measured in an in vitro assay for inhibition of protease activity.
  • a test protein can also be evaluated for selectivity toward different protease(s).
  • a test protein is assayed for its potency toward a panel of proteases and other enzymes and an IC50 value is determined for each.
  • a protein that demonstrates a low IC50 value for the target protease, and a higher IC5O value for other proteases within the test panel e.g., trypsin, plasmin, chymotrypsin
  • a protein is deemed selective if its IC50 value is at least one order of magnitude less than the next smallest IC50 value measured in the panel of enzymes.
  • binding protein/inhibitor activity in vivo or in samples (e.g., serum, joint tissue) of subjects to which a compound described herein has been administered.
  • protease binding proteins/inhihibtors useful in the methods and compositions provided herein are described in further detail below.
  • Kallikreins are serine proteases found in both tissues and plasma [see, for example, U.S. Patent No. 6,333,402 to Markland]. Plasma kallikrein is involved in contact-activated (intrinsic pathway) coagulation, fibrinolysis, hypotension, and inflammation [See Bhoola, K.D., CD. Figueroa, and K. Worthy, Pharmacological Reviews (1992) 44(1)1-80]. These effects of kallikrein are mediated through the activities of three distinct physiological substrates: i) Factor XII (coagulation), ii) Pro-urokinase/plasminogen (fibrinolysis), and iii) Kininogens (hypotension and inflammation).
  • Kallikrein cleavage of kininogens results in the production of kinins, small highly potent bioactive peptides.
  • the kinins act through cell surface receptors, designated BK-I and BK-2, present on a variety of cell types including endothelia, epithelia, smooth muscle, neural, glandular and hematopoietic.
  • Intracellular heterotrimeric G-proteins link the kinin receptors to second messenger pathways including nitric oxide, adenyl cyclase, phospholipase A 2 and phospholipase C.
  • kinins mediate the life-threatening vascular shock and edema associated with bacteremia (sepsis) or trauma, the edema and airway hyperreactivity of asthma, and both inflammatory and neurogenic pain associated with tissue injury.
  • bacteremia bacteremia
  • HAE hereditary angioedema
  • HAE is due to a genetic deficiency of Cl -inhibitor, the principal endogenous inhibitor of plasma kallikrein. Symptoms of HAE include edema of the skin, subcutaneous tissues and gastrointestinal tract, and abdominal pain and vomiting. Nearly one-third of HAE patients die by suffocation due to edema of the larynx and upper respiratory tract. Kallikrein is secreted as a zymogen (prekallikrein) that circulates as an inactive molecule until activated by a proteolytic event. [Genebank entry P03952 shows Human Plasma Prekallikrein.]
  • bovine pancreatic trypsin inhibitor also known as BPTI, aprotinin, or TRAS YLOLTM
  • K 1 320 pM
  • BPTI BPTI
  • aprotinin TRAS YLOLTM
  • K 1 for plasma Kallikrein 30 nM (i.e., 30,000 pM).
  • the G36S mutant had a K 1 Of over 500 nM.
  • Markland et al. [U.S. Patent Nos. 6,333,402; 5,994,125; 6,057,287; and 5,795,865] claim a number of derivatives having high affinity and specificity in inhibiting human plasma kallikrein.
  • One of these proteins is being tested in human patients who have HAE. Early indications are that the compound is safe and effective.
  • US Patent No. 7,064,107 by Ladner, et al. describes and claims a number of derivatives having high affinity and specificity in inhibiting human plasma kallikrein.
  • a number of useful inhibitors of kallikrein include a Kunitz domain.
  • a "Kunitz domain” is a polypeptide domain having at least 51 amino acids and containing at least two, and preferably three, disulfides.
  • the domain is folded such that the first and sixth cysteines, the second and fourth, and the third and fifth cysteines form disulfide bonds (e.g., in a Kunitz domain having 58 amino acids, cysteines can be present at positions corresponding to amino acids 5, 14, 30, 38, 51, and 55, according to the number of the BPTI sequence provided below, and disulfides can form between the cysteines at position 5 and 55, 14 and 38, and 30 and 51), or, if two disulfides are present, they can form between a corresponding subset of cysteines thereof.
  • the spacing between respective cysteines can be within 7, 5, 4, 3 or 2 amino acids of the following spacing between positions corresponding to: 5 to 55, 14 to 38, and 30 to 51, according to the numbering of the BPTI sequence provided below.
  • the BPTI sequence can be used a reference to refer to specific positions in any generic Kunitz domain. Comparison of a Kunitz domain of interest to BPTI can be performed by identifying the best fit alignment in which the number of aligned cysteines in maximized.
  • the 3D structure (at high resolution) of the Kunitz domain of BPTI is known.
  • One of the X- ray structures is deposited in the Brookhaven Protein Data Bank as "6PTI”.
  • the 3D structure of some BPTI homologues (Eigenbrot et al, (1990) Protein Engineering, 3(7):591-598; Hynes et al, (1990) Biochemistry, 29:10018-10022) are known.
  • At least seventy Kunitz domain sequences are known.
  • Known human homologues include three Kunitz domains of LACI (Wun et al, (1988) J. Biol. Chem.
  • LACI is a human serum phosphoglycoprotein with a molecular weight of 39 kDa (amino acid sequence in Table 1) containing three Kunitz domains.
  • LACI-Kl The Kunitz domains of LACI are referred to as LACI-Kl (residues 50 to 107), LACI-K2 (residues 121 to 178), and LACI-K3 (213 to 270).
  • the cDNA sequence of LACI is reported in Wun et al. (J. Biol. Chem., 1988, 263(13):6001-6004). Girard et al. (Nature, 1989, 338:518-20) reports mutational studies in which the Pl residues of each of the three Kunitz domains were altered.
  • LACI- Kl inhibits Factor Vila (F.Vila) when FVIIa is complexed to tissue factor and LACI-K2 inhibits Factor Xa.
  • a variety of methods can be used to identify a Kunitz domain from a sequence database.
  • a known amino acid sequence of a Kunitz domain, a consensus sequence, or a motif e.g., the ProSite Motif
  • GenBank sequence databases National Center for Biotechnology Information, National Institutes of Health, Bethesda MD
  • Pfam database of HMMs Hidden Markov Models
  • Pfam Accession Number PFOOO 14 of Pfam Release 9 provides numerous Kunitz domains and an HMM for identifying Kunitz domains.
  • the SMART database (Simple Modular Architecture Research Tool, EMBL, Heidelberg, DE) of HMMs as described in Schultz et al. (1998), Proc. Natl. Acad. ScL USA 95:5857 and Schultz et al. (2000) Nucl. Acids Res 28:231.
  • the SMART database contains domains identified by profiling with the hidden Markov models of the HMMer2 search program (R. Durbin et al. (1998) Biological sequence analysis: probabilistic models of proteins and nucleic acids. Cambridge University Press). The database also is annotated and monitored.
  • the ProDom protein domain database consists of an automatic compilation of homologous domains (Corpet et al. (1999), Nucl. Acids Res. 27:263-267).
  • Kunitz domains interact with target protease using, primarily, amino acids in two loop regions ("binding loops").
  • the first loop region is between about residues corresponding to amino acids 15-20 of BPTI.
  • the second loop region is between about residues corresponding to amino acids 31-37 of BPTI.
  • An exemplary library of Kunitz domains varies one or more amino acid positions in the first and/or second loop regions.
  • Particularly useful positions to vary, when screening for Kunitz domains that interact with kallikrein or when selecting for improved affinity variants include: positions 13, 16, 17, 18, 19, 31, 32, 34, and 39 with respect to the sequence of BPTI. At least some of these positions are expected to be in close contact with the target protease. It is also useful to vary other positions, e.g., positions that are adjacent to the aforementioned positions in the three-dimensional structure.
  • the "framework region" of a Kunitz domain is defined as those residues that are a part of the Kunitz domain, but specifically excluding residues in the first and second binding loop regions, i.e., about residues corresponding to amino acids 15-20 of BPTI and 31-37 of BPTI. Conversely, residues that are not in the binding loop may tolerate a wider range of amino acid substitution (e.g., conservative and/or non-conservative substitutions).
  • these Kunitz domains are variant forms of the looped structure including Kunitz domain 1 of human lipoprotein-associated coagulation inhibitor (LACI) protein.
  • LACI contains three internal, well-defined, peptide loop structures that are paradigm Kunitz domains (Girard, T. et al., 1989. Nature, 338:518-520). Variants of Kunitz domain 1 of LACI described herein have been screened, isolated and bind kallikrein with enhanced affinity and specificity (see, for example, U.S. Pat. Nos. 5,795,865 and 6,057,287). These methods can also be applied to other Kunitz domain frameworks to obtain other Kunitz domains that interact with kallikrein, e.g., plasma kallikrein.
  • Useful modulators of kallikrein function typically bind and/or inhibit kallikrein, as determined using kallikrein binding and inhibition assays.
  • An exemplary polypeptide that includes a Kunitz domain that inhibits kallikrein has the amino acid sequence defined by amino acids 3-60 of SEQ ID NO:2.
  • Another exemplary polypeptide that includes a Kunitz domain that inhibits kallikrein has the amino acid sequence defined by SEQ ID NO:2.
  • An exemplary polypeptide includes the amino acid sequence:
  • Xaa can by any amino acid except cysteine.
  • XaalO can be Asp or Glu
  • Xaall can be Asp, , SGelry, VaI, Asn, He, Ala or Thr
  • Xaal3 can be Pro, Arg, His, Asn, Ser, Thr, Ala, , G Lylys or Gln
  • Xaal5 can be Arg, Lys, Ala, Ser, Gly, Met, Asn or Gln
  • Xaa16 can be Ala, G, Slyer, Asp or Asn
  • Xaal7 can be Ala, Asn, Ser, He, Gly, VaI, Gln or Thr
  • Xaal8 can be His, Leu, Gln or Ala
  • Xaal9 can be Pro, Gln, Leu, Asn or He
  • Xaa21 can be Trp, Phe, Tyr, His or He
  • XaalO can be As
  • Amino acids Xaa6, Xaa7, Xaa8, Xaa9, Xaa20, Xaa24, Xaa25, Xaa26, Xaa27, Xaa28, Xaa29, Xaa41, Xaa42, Xaa44, Xaa46, Xaa47, Xaa48, Xaa49, Xaa50, Xaa52, Xaa53 and Xaa54 can be any amino acid.
  • each of the first four and at last three amino acids of SEQ ID NO: 1 can optionally be present or absent and can be any amino acid, if present, e.g., any non-cysteine amino acid.
  • the polypeptide has a sequence with one or more of the following properties: Xaall can be Asp, Gly, Ser or VaI; Xaal3 can be Pro, Arg, His or Asn; Xaal5 can be Arg or Lys; Xaa16 can be Ala or Gl;y Xaal7 can be Ala, Asn, Ser or He; Xaal8 can be His, Leu or Gln; Xaal9 can be Pro, Gln or Leu; Xaa21 can be Trp or Phe; Xaa31 is Glu; Xaa32 can be Glu or Gln; Xaa34 can be He, Thr or Ser; Xaa35 is Tyr; and Xaa39 can be Glu, or AGlaly.
  • Xaall can be Asp, Gly, Ser or VaI
  • Xaal3 can be Pro, Arg, His or Asn
  • Xaal5 can be Arg or Lys
  • An exemplary polypeptide can include the following amino acids: XaalO is Asp; Xaall is Asp; Xaal3 can be Pro or Arg; Xaal5 is Arg; Xaa16 can be Ala or G; Xlyaal7 is Ala; Xaal8 is His; Xaal9 is Pro;Xaa21 is Trp; Xaa31 is Glu; Xaa32 is Glu; Xaa34 can be He or Ser; Xaa35 is Tyr; and Xaa39 is Gly.
  • polypeptides could include binding domains for specific kallikrein epitopes.
  • binding loops of Kunitz domains can by cyclized and used in isolation or can be grafted onto another domain, e.g., a framework of another Kunitz domain. It is also possible to remove one, two, three, or four amino acids from the N-terminus of an amino acid sequence described herein, and/or one, two, three, four, or five amino acids from the C-terminus of an amino acid sequence described herein.
  • sequences encompassed by SEQ ID NO:1 are described by the following (where not indicated, “Xaa” refers to any amino acid, any non-cysteine amino acid or any amino acid from the same set of amino acids that are allowed for SEQ ID NO: 1):
  • sequence include those that differ by at least one amino acid, but fewer than seven, six, five, four, three, or two amino acids differences relative to an amino acid sequence described herein, e.g., an amino acid sequence provided above.
  • the first binding loop may have no differences relative to an amino acid sequence described herein, e.g., an amino acid sequence provided above.
  • neither the first nor the second binding loop differs from an amino acid sequence described herein, e.g., an amino acid sequence provided above.
  • the polypeptide that inhibits kallikrein is aprotinin.
  • the polypeptide is other than aprotinin, e.g., differs from aprotinin, by at least one, two, three, five, ten, or fifteen amino acids.
  • Polypeptides described herein can be made synthetically using any standard polypeptide synthesis protocol and equipment.
  • the stepwise synthesis of a polypeptide can be carried out by the removal of an amino (N) terminal-protecting group from an initial (i.e., carboxy-terminal) amino acid, and coupling thereto of the carboxyl end of the next amino acid in the sequence of the polypeptide. This amino acid is also suitably protected.
  • the carboxyl group of the incoming amino acid can be activated to react with the N-terminus of the bound amino acid by formation into a reactive group such as formation into a carbodiimide, a symmetric acid anhydride, or an "active ester" group such as hydroxybenzotriazole or pentafluorophenyl esters.
  • Preferred solid-phase peptide synthesis methods include the BOC method, which utilizes tert-butyloxycarbonyl as the I-amino protecting group, and the FMOC method, which utilizes 9-fluorenylmethloxycarbonyl to protect the I-amino of the amino acid residues. Both methods are well known to those of skill in the art (Stewart, J.
  • Polypeptides can also be produced using recombinant technology.
  • Recombinant methods can employ any of a number of cells and corresponding expression vectors, including but not limited to bacterial expression vectors, yeast expression vectors, baculovirus expression vectors, mammalian viral expression vectors, and the like.
  • a polypeptide described herein can be produced by a transgenic animal, e.g., in the mammary gland of a transgenic animal.
  • Part or all of the additional sequence can be removed, e.g., by protease digestion.
  • An exemplary recombinant expression system for producing a polypeptide that inhibits kallikrein is a yeast expression vector, which permits a nucleic acid sequence encoding the amino acid sequence for the inhibitor polypeptide to be linked in the same reading frame with a nucleotide sequence encoding the MAT ⁇ prepro leader peptide sequence of Saccharomyces cerevisiae, which in turn is under the control of an operable yeast promoter.
  • the resulting recombinant yeast expression plasmid can be transformed by standard methods into the cells of an appropriate, compatible yeast host, which cells are able to express the recombinant protein from the recombinant yeast expression vector.
  • a host yeast cell transformed with such a recombinant expression vector is also able to process the fusion protein to provide an active inhibitor polypeptide.
  • Another exemplary yeast host for producing recombinant polypeptides is Pichia pastoris.
  • polypeptides that inhibit kallikrein can include a Kunitz domain polypeptide described herein.
  • Some polypeptides can include an additional flanking sequence, preferably of one to six (e.g., 1, 2, 3, 4, 5, or 6) amino acids in length, at the amino and/or carboxy-terminal end, provided such additional amino acids do not significantly diminish kallikrein binding affinity or kallikrein inhibition activity so as to preclude use in the methods and compositions described herein.
  • additional amino acids can be deliberately added to express a polypeptide in a particular recombinant host cell or can be added to provide an additional function, e.g., to provide a linker to another molecule or to provide an affinity moiety that facilitates purification of the polypeptide.
  • the additional amino acid(s) do not include cysteine, which could interfere with the disulfide bonds of the Kunitz domain.
  • an inhibitor of kallikrein e.g., a polypeptide inhibitor
  • the surprisingly high binding affinities of such kallikrein inhibitors combined with their high degree of specificity for kallikrein to the exclusion of other molecular targets provide for particularly useful inhibitors.
  • inhibitors with lesser affinity or specificity also have their applications.
  • a typical Kunitz domain e.g., that includes, SEQ ID NO:1, contains a number of invariant positions, e.g., positions corresponding to position 5, 14, 30, 51 and 55 in the BPTI numbering scheme are cysteine.
  • the spacing between these positions may vary to the extent allowable within the Kunitz domain fold, e.g., such that three disulfide bonds are formed.
  • Other positions such as, for example, positions 6, 7, 8, 9, 20, 24, 25, 26, 27, 28, 29, 41, 42, 44, 46, 47, 48, 49, 50, 52, 53 and 54, or positions corresponding to those positions, can be any amino acid (including non-naturally occurring amino acids).
  • one or more amino acids correspond to that of a native sequence.
  • at least one variable position is different from that of the native sequence.
  • the amino acids can each be individually or collectively substituted by a conservative or non-conservative amino acid substitution.
  • amino acid substitutions replace an amino acid with another amino acid of similar chemical structure and may have no affect on protein function.
  • Non-conservative amino acid substitutions replace an amino acid with another amino acid of dissimilar chemical structure.
  • conserved amino acid substitutions include, for example, Asn->Asp, Arg->Lys and Ser- >Thr.
  • 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 and/or 21 of these amino acids can be independently or collectively, in any combination, selected to correspond to the corresponding position of SEQ ID NO:2.
  • positions 10, 11, 13, 15, 16, 17, 18, 19, 21, 22, 23, 31, 32, 34, 35, 39, 40, 43 and 45, or positions corresponding to those positions can be any of a selected set of amino acids.
  • SEQ ID NO: 1 defines a set of possible sequences. Each member of this set contains, for example, a cysteine at positions 5, 14, 30, 51 and 55, and any one of a specific set of amino acids at positions 10, 11, 13, 15, 16, 17, 18, 19, 221, 22, 23, 31, 32, 34, 35, 39, 40, 43 and 45, or positions corresponding to those positions.
  • 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 and/or 19 of these amino acids can be independently or collectively, in any combination, selected to correspond to the corresponding position of SEQ ID NO:2.
  • the polypeptide preferably has at least 80%, 85%, 90%, 95, 97, 98, or 99% identity to SEQ ID NO:2.
  • Useful polypeptides can also be encoded by a nucleic acid that hybridizes to a nucleic acid that encodes a polypeptide described herein.
  • the nucleic acids can hybridize under medium, high, or very high stringency conditions.
  • hybridizes under low stringency, medium stringency, high stringency, or very high stringency conditions describes conditions for hybridization and washing.
  • Guidance for performing hybridization reactions can be found in Current Protocols in Molecular Biology, John Wiley & Sons, N.Y. (1989), 6.3.1-6.3.6, which is incorporated by reference. Aqueous and nonaqueous methods are described in that reference and either can be used.
  • Specific hybridization conditions referred to herein are as follows: (1) low stringency hybridization conditions in 6X sodium chloride/sodium citrate (SSC) at about 45°C, followed by two washes in 0.2X SSC, 0.1% SDS at least at 50°C (the temperature of the washes can be increased to 55°C for low stringency conditions); (2) medium stringency hybridization conditions in 6X SSC at about 45°C, followed by one or more washes in 0.2X SSC, 0.1% SDS at 60°C; (3) high stringency hybridization conditions in 6X SSC at about 45°C, followed by one or more washes in 0.2X SSC, 0.1% SDS at 65°C; and (4) very high stringency hybridization conditions are 0.5M sodium phosphate, 7% SDS at 65°C, followed by one or more washes at 0.2X SSC, 1% SDS at 65°C.
  • SSC sodium chloride/sodium citrate
  • One class of kallikrein inhibitors includes antibodies.
  • Exemplary antibodies bind, e.g., specifically to kallikrein, e.g., plasma kallikrein.
  • An antibody can inhibit kallikrein in a number of ways. For example, it can contact one or more residues of the active site, sterically hinder or obstruct access to the active site, prevent maturation of kallikrein, or destabilize a conformation required for catalytic activity.
  • One or more regions of an antibody can be human or effectively human.
  • one or more of the variable regions can be human or effectively human.
  • one or more of the CDRs can be human, e.g., HC CDRl, HC CDR2, HC CDR3, LC CDRl, LC CDR2, and LC CDR3.
  • Each of the light chain CDRs can be human.
  • HC CDR3 can be human.
  • One or more of the framework regions can be human, e.g., FRl, FR2, FR3, and FR4 of the HC or LC.
  • all the framework regions are human, e.g., derived from a human somatic cell, e.g., a hematopoietic cell that produces immunoglobulins or a non-hematopoietic cell.
  • the human sequences are germline sequences, e.g., encoded by a germline nucleic acid.
  • One or more of the constant regions can be human or effectively human.
  • at least 70, 75, 80, 85, 90, 92, 95, or 98% of, or the entire antibody can be human or effectively human.
  • an “effectively human” immunoglobulin variable region is an immunoglobulin variable region that includes a sufficient number of human framework amino acid positions such that the immunoglobulin variable region does not elicit an immunogenic response in a normal human.
  • An “effectively human” antibody is an antibody that includes a sufficient number of human amino acid positions such that the antibody does not elicit an immunogenic response in a normal human.
  • All or part of an antibody can be encoded by an immunoglobulin gene or a segment thereof.
  • exemplary human immunoglobulin genes include the kappa, lambda, alpha (IgAl and IgA2), gamma (IgGl, IgG2, IgG3, and IgG4), delta, epsilon and mu constant region genes, as well as the myriad immunoglobulin variable region genes.
  • Full-length immunoglobulin "light chains" (about 25 Kd or 214 amino acids) are encoded by a variable region gene at the NH2-terminus (about 110 amino acids) and a kappa or lambda constant region gene at the COOH- terminus.
  • variable region gene (about 116 amino acids) and one of the other aforementioned constant region genes, e.g., gamma (encoding about 330 amino acids).
  • One exemplary method for identifying antibodies that bind to and inhibit kallikrein includes immunizing a non-human animal with kallikrein or a fragment thereof. Even small peptides can be used as immunogens. In one embodiment, a mutated kallikrein which has reduced or no catalytic activity is used as immunogen. Spleen cells can be isolated from the immunized animal and used to produce hybridoma cells using standard methods. In one embodiment, the non-human animal includes one or more human immunoglobulin genes.
  • Another exemplary method for identifying proteins that bind to and inhibit kallikrein includes: providing a library of proteins and selecting from the library one or more proteins that bind to a kallikrein or a fragment thereof.
  • the selection can be performed in a number of ways.
  • the library can be provided in the format of a display library or a protein array.
  • the library can be pre-screened (e.g., depleted) to remove members that interact with a non-target molecule, e.g., protease other than a kallikrein or a kallikrein in which the active site is inaccessible, e.g., bound by an inhibitor, e.g., aprotinin.
  • Antibody libraries e.g., antibody display libraries
  • Antibody libraries can be constructed by a number of processes (see, e.g., de Haard et al. (1999) /. Biol. Chem 274:18218-30; Hoogenboom et al. (1998) Immunotechnology 4:1-20. and Hoogenboom et al. (2000) Immunol Today 21:371-8). Further, elements of each process can be combined with those of other processes. The processes can be used such that variation is introduced into a single immunoglobulin domain (e.g., VH or VL) or into multiple immunoglobulin domains (e.g., VH and VL).
  • variation can be introduced into an immunoglobulin variable domain, e.g., in the region of one or more of CDRl, CDR2, CDR3, FRl, FR2, FR3, and FR4, referring to such regions of either and both of heavy and light chain variable domains.
  • variation is introduced into all three CDRs of a given variable domain.
  • the variation is introduced into CDRl and CDR2, e.g., of a heavy chain variable domain. Any combination is feasible.
  • a recombinant expression vector encoding both the antibody heavy chain and the antibody light chain is introduced into dhfr- CHO cells by calcium phosphate-mediated transfection.
  • the antibody heavy and light chain genes are each operatively linked to enhancer/promoter regulatory elements (e.g., derived from SV40, CMV, adenovirus and the like, such as a CMV enhancer/AdMLP promoter regulatory element or an SV40 enhancer/AdMLP promoter regulatory element) to drive high levels of transcription of the genes.
  • the recombinant expression vector also carries a DHFR gene, which allows for selection of CHO cells that have been transfected with the vector using methotrexate selection/amplification.
  • the selected transformant host cells are cultured to allow for expression of the antibody heavy and light chains and intact antibody is recovered from the culture medium.
  • Standard molecular biology techniques are used to prepare the recombinant expression vector, transfect the host cells, select for transformants, culture the host cells, and recover the antibody from the culture medium. For example, some antibodies can be isolated by affinity chromatography with a Protein A or Protein G. Antibodies can also be produced by a transgenic animal.
  • a binding ligand can include a peptide of 32 amino acids or less that independently binds to a target molecule. Some such peptides can include one or more disulfide bonds. Other peptides, so- called “linear peptides,” are devoid of cysteines. In one embodiment, the peptides are artificial, i.e., not present in a nature or not present in a protein encoded by one or more genomes of interest, e.g., the human genome. Synthetic peptides may have little or no structure in solution (e.g., unstructured), heterogeneous structures (e.g., alternative conformations or "loosely” structured), or a singular native structure (e.g., cooperatively folded).
  • Some synthetic peptides adopt a particular structure when bound to a target molecule.
  • Some exemplary synthetic peptides are so-called "cyclic peptides" that have at least a disulfide bond and, for example, a loop of about 4 to 12 non-cysteine residues.
  • Exemplary peptides are less than 28, 24, 20, or 18 amino acids in length.
  • Peptide sequences that independently bind kallkrein can be identified by any of a variety of methods. For example, they can be selected from a display library or an array of peptides. After identification, such peptides can be produced synthetically or by recombinant means. The sequences can be incorporated (e.g., inserted, appended, or attached) into longer sequences.
  • Each library displays a short, variegated exogenous peptide on the surface of M 13 phage.
  • the peptide display of five of the libraries was based on a parental domain having a segment of 4, 5, 6, 7, 8, 10, 11, or 12 amino acids, respectively, flanked by cysteine residues.
  • the pairs of cysteines are believed to form stable disulfide bonds, yielding a cyclic display peptide.
  • the cyclic peptides are displayed at the amino terminus of protein III on the surface of the phage.
  • the libraries were designated TN6/7, TN7/4, TN8/9, TN9/4, TNlO/10, TNll/1, and TN12/1.
  • a phage library with a 20-amino acid linear display was also screened; this library was designated Lin20.
  • the TN6/7 library was constructed to display a single cyclic peptide contained in a 12-amino acid variegated template.
  • the TN6/6 library utilized a template sequence of Xaai-Xaa 2 -Xaa 3 -Cys 4 - Xaa5-Xaa6-Xaa7-Xaa8-Cys9-Xaaio-Xaan-Xaai2, where each variable amino acid position in the amino acid sequence of the template is indicated by a subscript integer.
  • Each variable amino acid position (Xaa) in the template was varied to contain any of the common ⁇ -amino acids, except cysteine (Cys).
  • the TN7/4 library was constructed to display a single cyclic peptide contained in a 12-amino acid variegated template.
  • the TN7/4 library utilized a template sequence of Xaai-Xaa 2 -Xaa 3 -Cys 4 - Xaa 5 -Xaa 6 -Xaa 7 -Xaa 8 -Xaa 9 -Cysio-Xaan-Xaai 2 -Xaai 3 , where each variable amino acid position in the amino acid sequence of the template is indicated by a subscript integer.
  • Each variable amino acid position (Xaa) in the template was varied to contain any of the common ⁇ -amino acids, except cysteine (Cys).
  • the TN 8/9 library was constructed to display a single binding loop contained in a 14-amino acid template.
  • the TN8/9 library utilized a template sequence of Xaai-Xaa 2 -Xaa 3 -Cys-Xaa 5 - Xaa 6 -
  • the TN9/4 library was constructed to display a single binding loop contained in a 15 -amino acid template.
  • the TN9/4 library utilized a template sequence Xaai-Xaa 2 -Xaa 3 -Cys 4 -Xaa 5 -Xaag- Xaa 7 -Xaa 8 -Xaa9-Xaa 10 -Xaa 11 -Cys 12 -Xaa 13 -Xaa 14 -Xaa 1 5.
  • Each variable amino acid position (Xaa) in the template were varied to permit any amino acid except cysteine (Cys).
  • the TNlO/10 library was constructed to display a single cyclic peptide contained in a 16-amino acid variegated template.
  • the TN 10/9 library utilized a template sequence Xaai-Xaa 2 -Xaa 3 -Cys 4 - Xaa5-Xaa 6 - Xaa 7 -Xaa 8 -Xaa 9 -Xaa lo -Xaa 11 -Xaa 12 -Cys 13 -Xaa 14 -Xaa 1 5-Xaa 16 , where each variable amino acid position in the amino acid sequence of the template is indicated by a subscript integer.
  • Each variable amino acid position (Xaa) was to permit any amino acid except cysteine (Cys).
  • the TNl 1/1 library was constructed to display a single cyclic peptide contained in a 17-amino acid variegated template.
  • the TNl 1/1 library utilized a template sequence Xaai-Xaa 2 -Xaa 3 -Cys 4 - Xaa5-Xaa 6 -Xaa 7 -Xaa 8 -Xaa 9 -Xaa lo -Xaa 11 -Xaa 12 -Xaa 13 -Cys 14 -Xaa 1 5-Xaa 16 -Xaa 17 , where each variable amino acid position in the amino acid sequence of the template is indicated by a subscript integer.
  • Each variable amino acid position (Xaa) was to permit any amino acid except cysteine (Cys).
  • the TN12/1 library was constructed to display a single cyclic peptide contained in an 18-amino acid template.
  • the TN12/1 library utilized a template sequence Xaai-Xaa 2 -Xaa 3 -Cys 4 -Xaa 5 -Xaa6- Xaa7-Xaa8-Xaa9-Xaaio-Xaan-Xaai2-Xaai3-Xaai4-Cysi5-Xaa16-Xaai7-Xaai8, where each variable amino acid position in the amino acid sequence of the template is indicated by a subscript integer.
  • the amino acid positions Xaai, Xaa 2 , Xaa 17 and Xaa 18 of the template were varied, independently, to permit each amino acid selected from the group of 12 amino acids consisting of Ala, Asp, Phe, , Gly His, Leu, Asn, Pro, Arg, Ser, Trp, and Tyr.
  • the amino acid positions Xaa 3 , Xaa 5 , Xaa 6 , Xaa 7 , Xaa 8 , Xaa 9 , Xaaio, Xaan, Xaai2, Xaa 13 , Xaai4, Xaa 16 , of the template were varied, independently, to permit any amino acid except cysteine (Cys).
  • the Lin20 library was constructed to display a single linear peptide in a 20-amino acid template.
  • the amino acids at each position in the template were varied to permit any amino acid except cysteine (Cys).
  • the techniques discussed in Kay et al., Phage Display of Peptides and Proteins: A Laboratory Manual (Academic Press, Inc., San Diego 1996) and U.S. Patent Number 5,223,409 are useful for preparing a library of potential binders corresponding to the selected parental template.
  • the libraries described above can be prepared according to such techniques, and screened, e.g., as described above, for peptides that bind to and inhibit kallikrein.
  • phage libraries or selected populations from phage libraries can be counter-selected, e.g., using kallikrein that is inactivated, e.g., by binding of aprotinin or another kallikrein inhibitor. Such procedures can be used to discard peptides that do not contact the active site.
  • Peptides can also be synthesized using alternative backbones, e.g., a peptoid backbone, e.g., to produce a compound which has increased protease resistance.
  • this method can be used to make a compound that binds to and inhibits kallikrein and which is not itself effectively cleaved by kallikrein.
  • Plasmin is a serine protease derived from plasminogen.
  • the catalytic domain of plasmin (or "CatDom") cuts peptide bonds, particularly after arginine residues and to a lesser extent after lysines and is highly homologous to trypsin, chymotrypsin, kallikrein, and many other serine proteases.
  • Most of the specificity of plasmin derives from the kringle domains of plasmin binding of fibrin (Lucas et al., J Biological Chem (1983) 258(7)4249-56.; Varadi & Patthy, Biochemistry (1983) 22:2440-2446.; and Varadi & Patthy, Biochemistry (1984) 23:2108-2112.).
  • the agent mainly responsible for fibrinolysis is plasmin, the activated form of plasminogen.
  • plasminogen many substances can activate plasminogen, including activated Hageman factor, streptokinase, urokinase (uPA), tissue-type plasminogen activator (tPA), and plasma kallikrein (pKA).
  • pKA is both an activator of the zymogen form of urokinase and a direct plasminogen activator.
  • Plasmin is undetectable in normal circulating blood, but plasminogen, the zymogen, is present at about 3 ⁇ M. An additional, unmeasured amount of plasminogen is bound to fibrin and other components of the extracellular matrix and cell surfaces.
  • Normal blood contains the physiological inhibitor of plasmin, ⁇ 2-plasmin inhibitor (( ⁇ 2 -PI), at about 2 ⁇ M. Plasmin and ⁇ 2 -PI form a 1:1 complex. Matrix or cell bound-plasmin is relatively inaccessible to inhibition by ⁇ 2 -PI. Thus, activation of plasmin can exceed the neutralizing capacity of ⁇ 2 -PI causing a profibrinolytic state.
  • Plasmin once formed: i) degrades fibrin clots, sometimes prematurely; ii) digests fibrinogen (the building material of clots) impairing hemostasis by causing formation of friable, easily lysed clots from the degradation products, and inhibition of platelet adhesion/aggregation by the fibrinogen degradation products; iii) interacts directly with platelets to cleave glycoproteins Ib and Ilb/IIIa preventing adhesion to injured endothelium in areas of high shear blood flow and impairing the aggregation response needed for platelet plug formation (Adelman et al., Blood (1986) 68(6)1280-1284.); iv) proteolytically inactivates enzymes in the extrinsic coagulation pathway further promoting a prolytic state.
  • Robbins (Robbins, Chapter 21 of Hemostasis and Thrombosis, Colman, R. W., J. Hirsh, V. J. Marder, and E. W. Salzman, Editors, Second Edition, 1987, J. B. Lippincott Company, Philadelphia, PA) reviewed the plasminogen-plasmin system in detail.
  • Markland et al. [U.S. Patent Nos. 6,010,880; 6,071,723; and 6,103,49] claim a number of derivatives having high affinity and specificity in inhibiting plasmin.
  • the DX-1000 protein includes the framework region of human LACI, but other frameworks can also be used.
  • the sequence of DX-1000 can include the following amino acid sequence (SEQ ID NO: 100):
  • sequence can also be preceded by two N-terminal amino acids (“EA”) to include the following sequence (SEQ ID NO:200):
  • DX-1000 was tested in several functional cell -based activity assays and demonstrated potent inhibitory activity. Firstly, DX-1000 (InM) inhibited both DHT-stimulated invasion of LNCaPs (prostate cancer) and HT-1080 (fibrosarcoma) through Matrigel, processes known to be dependent on the plasminogen/plasmin system. Interestingly, DX-1000 down-regulated efficiently the expression and activation of gelatinases, directly involved in cancer cell invasion and ECM proteolysis. In addition, DX-1000 (1-1OnM) efficiently blocked tube formation of human and mouse endothelial cells whether plated on Matrigel or collagen type I. Concerning the haemostatic aspect, DX-1000 showed no clinically significant effects on global coagulation screening tests or a platelet function screening test.
  • DX-1000 can be modified, e.g., by pegylation. It has a three available lysines and an N- terminus for modification with mPEG, one, two, or more of these positions can be modified (e.g., all four of these positions can be modified).
  • the compound 4xPEG DX-1000 is an exemplary modified DX-1000 molecule that includes four PEG moieties. DX-1000 can be combined with an mPEG succinimidyl propionic acid reagent having an average molecular weight of about 5 kDa or 7 kDa.
  • Xaal, Xaa2, Xaa3, Xaa4, Xaa56, Xaa57 and/or Xaa58 may be absent.
  • XaalO can be Asp, Glu, Tyr, or Gln.
  • Xaall can be Thr, Ala, Ser, VaI or Asp.
  • Xaal3 can be Pro, Leu or Ala.
  • Xaal5 can be Lys or Arg.
  • Xaa16 can be Ala or Gl.y
  • Xaal7 can be Arg, Lys or Ser.
  • Xaal 8 can be Phe or He.
  • Xaal9 can be Glu, Gln, Asp, Pro, G,ly Ser or He.
  • Xaa21 can be Phe, Tyr or Trp.
  • Xaa22 can be Tyr or Phe.
  • Xaa23 can be Tyr or Phe.
  • Xaa31 can be Asp, Glu, Thr, VaI, Gln or Ala.
  • Xaa32 can be Thr, Ala, Glu, Pro,or Gln.
  • Xaa34 can be VaI, He, Thr, Leu, Phe, Tyr, His, Asp, Ala, or Ser.
  • Xaa35 can be Tyr or Trp.
  • Xaa36 can be Gly or Ser.
  • Xaa39 can be Glu, , AGslyp, Arg, Ala, Gln, Leu, Lys, or Met.
  • Xaa40 can be Gly or Ala.
  • Xaa43 can be Asn or G;
  • l oyr Xaa45 can be Phe or Tyr.
  • Xaa can be any amino acid, particularly any non-cysteine amino acid.
  • XaalO can be Asp or Glu.
  • Xaall can be Thr, Ala, or Ser.
  • Xaal3 is Pro.
  • Xaal5 is Arg.
  • Xaa16 is Ala.
  • Xaal7 is Arg.
  • Xaal8 is Phe.
  • Xaa 19 can be Glu or Asp.
  • Xaa21 can be Phe or Trp.
  • Xaa22 can be Tyr or Phe.
  • Xaa23 can be Tyr or Phe.
  • Xaa31 can be Asp or Glu.
  • Xaa32 can be Thr, Ala, or Glu.
  • Xaa34 can be VaI, He or Thr.
  • Xaa35 is Tyr.
  • Xaa36 is .
  • XGalay39 can be Glu, , or Gly Asp.
  • Xaa40 can be Gly or Ala.
  • the protein includes at least 80, 85, 90, or 95% of the amino acid of the first and/or second binding loops of DX-1000.
  • the protein includes a framework region from a human Kunitz domain (e.g., a human Kunitz domain described herein).
  • Exemplary DX-1000 variants include proteins that have an amino acid sequence that differs by at least one, but fewer than eight, six, five, four, three, or two amino acid differences (e.g., substitutions, insertions, or deletions) from the amino acid sequence of DX-1000 (e.g., SEQ ID NO:200) or the amino acid sequence of SEQ ID NO: 100.
  • the differences may be in regions other than the first binding loop, or in regions other than the first and second binding loops, e.g., in the framework region.
  • the Kunitz domain does not naturally occur in humans, but may include an amino acid sequence that differs by fewer than ten, seven, or four amino acids from a human Kunitz domain (e.g., a human Kunitz domain described herein).
  • the K 1 of the compound for plasmin is within a factor of 0.5 to 1.5, 0.8 to 1.2, 0.3 to 3.0, 0.1 to 10.0, or 0.02 to 50.0 of the K 1 of DX-1000 for plasmin.
  • DX-1000 includes a Kunitz domain that inhibits plasmin. DX-1000 and related Kunitz domains are described herein.
  • One class of plasmin inhibitors includes antibodies.
  • Exemplary antibodies bind specifically to plasmin.
  • An antibody can inhibit plasmin in a number of ways. For example, it can contact one or more residues of the active site, sterically hinder or obstruct access to the active site, prevent maturation of plasmin, or destabilize a conformation required for catalytic activity.
  • the binding ligand can include a peptide of 32 amino acids or less that independently binds to a target molecule (e.g., plasmin). Some such peptides can include one or more disulfide bonds. Other peptides, so-called “linear peptides,” are devoid of cysteines. In one embodiment, the peptides are artificial, i.e., not present in a nature or not present in a protein encoded by one or more genomes of interest, e.g., the human genome.
  • Synthetic peptides may have little or no structure in solution (e.g., unstructured), heterogeneous structures (e.g., alternative conformations or "loosely” structured), or a singular native structure (e.g., cooperatively folded). Some synthetic peptides adopt a particular structure when bound to a target molecule. Some exemplary synthetic peptides are so-called "cyclic peptides" that have at least a disulfide bond and, for example, a loop of about 4 to 12 non-cysteine residues. Exemplary peptides are less than 28, 24, 20, or 18 amino acids in length.
  • MMP binding proteins include matrix metalloprotease binding proteins, or "MMP binding proteins", such as those of MMP-9, MMP-12, MMP-14, and MMP-2.
  • the binding proteins may in certain embodiments be antibody, peptide or Kunitz domain-based. Certain specific MMP binding proteins are described in further detail below.
  • Any MMP-9 binding protein may be used in the methods and compositions for treating inflammatory disorders that are disclosed herein.
  • MMP-9 is encoded by a gene designated as MMP9 with full name Matrix metalloproteinase-9 precursor. Synonyms for MMP-9 include matrix metalloproteinase 9, gelatinase B (GELB), 92kDa gelatinase (CLG4B), 92kDa type IV collagenase (EC 3.4.24.35).
  • the DNA sequence is known for Homo sapiens and Mus musculus.
  • An exemplary cDNA sequence encoding human MMP9 and the amino acid sequence are shown below.
  • Exemplary cDNA sequences encoding murine MMP9 and amino acid sequences are also shown below.
  • An exemplary MMP-9 protein can include the human or mouse MMP-9 amino acid sequence, a sequence that is 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identical to one of these sequences, or a fragment thereof, e.g., a fragment without the signal sequence or prodomain.
  • Table 2 shows the similar genes in other organisms and the percentage of similarity with human MMP-9.
  • gosspyii yeast (Ashbya gossypi ⁇ ), K. lactis yeast (Kluyveromyces lactis), medicago trunc (Medicago truncatula), malaria parasite ⁇ Plasmodium falciparum), schistosome parasite ⁇ Schistosoma mansoni), sorghum ⁇ Sorghum bicolor), toxoplasmosis ⁇ Toxoplasma gondii).
  • MMP-9 belongs to the peptidase MlOA family. MMP-9 consists of five domains; the amino-terminal and zinc-binding domains shared by all members of the secreted metalloprotease gene family, the collagen-binding fibronectin-like domain also present in the 72-kDa type IV collagenase, a carboxyl-terminal hemopexin-like domain shared by all known enzymes of this family with the exception of PUMP-I, and a unique 54-amino-acid- long proline-rich domain homologous to the alpha 2 chain of type V collagen (Wilhelm et al. (1989) /. Biol. Chem. 264, 17213-
  • MMP-9 The catalytic activity of MMP-9 is inhibited by histatin-3 1/24 (histatin-5).
  • MMP-9 is activated by urokinase-type plasminogen activator; plasminogen; IL-lbeta, 4-aminophenylmercuric acetate and phorbol ester.
  • MMP-9 exists as monomer, disulfide-linked homodimer, and as a heterodimer with a 25kDa protein. Macrophages and transformed cell lines produce only the monomeric MMP-9, the hetrodimeric form is produced by normal alveolar macrophages and granulocytes.
  • the processing of the precursor yields different active forms of 64, 67 and 82kDa.
  • Sequentially processing by MMP-3 yields the 82 kDa matrix metalloproteinase-9. In arthritis patients, this enzyme can contribute to the pathogenesis of joint destruction and can be a useful marker of disease status.
  • MMP-9 has a number of endogenous inhibitors. Like other MMPs, MMP-9 is inhibited by TIMPs (Murphy, G., and Willenbrock, F. (1995) Methods Enzymol. 248, 496-510).
  • TIMPs Methods Enzymol. 248, 496-510.
  • a characteristic of MMP-9 (and MMP-2) is the ability of their zymogens to form tight non-covalent and stable complexes with TIMPs. It has been shown that pro-MMP-2 binds TIMP-2 (Goldberg et al. (1989) Proc. Natl. Acad. Sci. U. S. A. 86, 8207-8211), whereas pro-MMP-9 binds TIMP-I (Wilhelm et al.
  • TIMPs typically are slow, tight binding inhibitors.
  • a MMP-9 binding protein e.g., antibody, peptide, Kunitz domain
  • recombinant TIMP-I can be administered to inhibit MMP-9, e.g., in combination with a MMP-9 binding protein decscribed herein.
  • Small molecule inhibitors of MMP-9 Small molecule inhibitors of MMP-9. Skiles et al. (2004, Curr Med Chem, 11:2911-77) reported that first generation small-molecule MMP inhibitors had poor bioavailability and the second generation had caused musculoskeletal pain and inflammation. Most small-molecule MMP inhibitors interact with the catalytic zinc but have fairly low affinity. Thus, a higher concentration is needed to have effect. The interaction with the catalytic zinc leads to inhibition of other MMPs and toxic side effects.
  • a MMP-9 binding protein described herein can be used in combination with a small molecule inhibitor. For example, because the inhibitors are used in combination, the dose of the small molecule used can be decreased and therefore result in fewer side effects.
  • small molecule MMP-9 inhibitors include small synthetic anthranilic acid-based inhibitors (see, e.g., Calbiochem Inhibitor-I, catalogue #444278 and Levin et al., 2001, Bioorg. Med. Chem. Lett. 11:2975-2978).
  • Small interfering RNA inhibitors of MMP-9 can be inhibited by small interfering RNA (siRNA).
  • siRNA small interfering RNA
  • Examples of siRNA that can be used include:
  • the siRNA can be administered to inhibit MMP-9, e.g., in combination with a MMP-9 binding protein decscribed herein.
  • proteins that bind to MMP-9 e.g., human MMP-9 and are either peptides, polypeptides that include at least one immunoglobin variable region, or Kunitz domains. Methods for discovering and selecting and improving such binding proteins are described further below.
  • the MMP-9 binding protein includes at least one immunoglobulin variable domain.
  • the MMP-9 binding protein includes a heavy chain (HC) immunoglobulin variable domain sequence and a light chain (LC) immunoglobulin variable domain sequence.
  • HC heavy chain
  • LC light chain
  • MMP-9 binding proteins may be antibodies.
  • MMP-9 binding antibodies may have their HC and LC variable domain sequences included in a single polypeptide (e.g., scFv), or on different polypeptides (e.g., IgG or Fab).
  • the MMP-9 binding protein may be an isolated peptide or protein (e.g., at least 70, 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, or 99% free of other proteins).
  • the MMP-9 binding protein may additionally inhibit MMP-9, e.g., human MMP-9.
  • the binding protein can inhibit the catalytic activity of MMP-9 (e.g., human MMP-9).
  • the protein binds the catalytic domain of human MMP-9, e.g., the protein contacts residues in or near the active site of MMP-9.
  • the protein does not contact residues in or near the active site of MMP-9 but instead binds elsewhere on MMP-9 and causes a steric change in MMP-9 that affects (e.g., inhibits) its activity.
  • the protein can bind to MMP-9, e.g., human MMP-9, with a binding affinity of at least 10 , 10 6 , 10 7 ,10 8 , 10 9 , 10 10 and 10 11 M -1 .
  • the protein binds to MMP-9 with a K off slower than 1 X 10 -3 , 5 X 10 -4 s -1 , or 1 X 10 -4 s -1 .
  • the protein binds to MMP-12 with a K 0n faster than 1 x 10 , 1 x 10 , or 5x 10 M s- .
  • the protein inhibits human MMP-9 activity, e.g., with a Ki of less than 10 -5 , 10 -6 , 10 -7 , 10 -8 , 10 -9 , and 10 -10 M.
  • the protein can have, for example, an IC50 of less than 100 nM, 10 nM or 1 nM. In some embodiments, the protein has an IC50 of about 1.8 nM.
  • the affinity of the protein for MMP-9 can be characterized by a K D of less than 100 nm, less than 10 nM, or about 3 nM (e.g., 3.1 nM), about 5 nM (e.g., 5 nM), about 6 nm (e.g., 5.9 nM), about 7 nM (e.g., 7.1 nM), or about 10 nM (e.g., 9.6 nM).
  • K D K D of less than 100 nm, less than 10 nM, or about 3 nM (e.g., 3.1 nM), about 5 nM (e.g., 5 nM), about 6 nm (e.g., 5.9 nM), about 7 nM (e.g., 7.1 nM), or about 10 nM (e.g., 9.6 nM).
  • the protein has a K D ⁇ 200 nM.
  • the protein has a tl/2 of at least about 10 minutes (e.g., 11 minutes), at least about 20 minutes (e.g., 18 minutes), at least about 25 minutes (e.g., 25 minutes), at least about 35 minutes (e.g., 33 minutes), or at least about 60 minutes (e.g., 57 minutes).
  • the protein binds the catalytic domain of human MMP-9, e.g., the protein contacts residues in or near the active site of MMP-9.
  • the protein does not contact residues in or near the active site of MMP-9 but instead binds elsewhere on MMP-9 and causes a steric change in MMP-9 that affects (e.g., inhibits) its activity.
  • Exemplary MMP-9 binding proteins include antibodies with a heavy chain (HC) and/or light chain (LC), and in some embodiments, an HC and/or LC variable domain, that is selected from the group of antibodies consisting of: DX-2802, 539A-M0240-B03, M0078-G07, M0081-D05, M0076- D03, M0072-H07, M0075-D12, M0166-F10, M0279-A03, M0279-B02, M0288-C08, and M0281- F06, or proteins that comprise the HC and/or LC CDRs of DX-2802, 539A-M0240-B03, M0078-G07, M0081-D05, M0076-D03, M0072-H07, M0075-D12, M0166-F10, M0279-A03, M0279-B02, M0288- C08, or M0281-F06.
  • MMP-9 binding proteins are further described in
  • the protein if an antibody, can include one or more of the following characteristics: (a) a human CDR or human framework region; (b) the HC immunoglobulin variable domain sequence comprises one or more CDRs that are at least 85, 88, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% identical to a CDR of a HC variable domain described above; (c) the LC immunoglobulin variable domain sequence comprises one or more CDRs that are at least 85, 88, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% identical to a CDR of a LC variable domain described above; (d) the LC immunoglobulin variable domain sequence is at least 85, 88, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% identical to a LC variable domain described above; (e) the HC immunoglobulin variable domain sequence is at
  • the HC and LC variable domain sequences are components of the same polypeptide chain. In another, the HC and LC variable domain sequences are components of different polypeptide chains.
  • the protein is an IgG, e.g., IgGl, IgG2, IgG3, or IgG4.
  • the protein can be a soluble Fab (sFab).
  • the protein includes a Fab2', scFv, minibody, scFv::Fc fusion, Fab::HSA fusion, HSA::Fab fusion, Fab::HSA::Fab fusion, or other molecule that comprises the antigen combining site of one of the binding proteins herein.
  • VH and VL regions of these Fabs can be provided as IgG, Fab, Fab2, Fab2', scFv, PEGylated Fab, PEGylated scFv, PEGylated Fab2, VH::CH1::HSA+LC, HSA::VH::CH1+LC, LC::HSA + VH::CH1, HSA::LC + VH::: CHl, or other appropriate construction.
  • the protein is a human or humanized antibody or is non-immunogenic in a human.
  • the protein includes one or more human antibody framework regions, e.g., all human framework regions.
  • the protein includes a human Fc domain, or an Fc domain that is at least 95, 96, 97, 98, or 99% identical to a human Fc domain.
  • the protein is a primate or primatized antibody or is non-immunogenic in a human.
  • the protein includes one or more primate antibody framework regions, e.g., all primate framework regions.
  • the protein includes a primate Fc domain, or an Fc domain that is at least 95, 96, 97, 98, or 99% identical to a primate Fc domain.
  • "Primate” includes humans ⁇ Homo sapiens), chimpanzees ⁇ Pan troglodytes and Pan paniscus (bonobos)), gorillas ⁇ Gorilla gorilla), gibons, monkeys, lemurs, aye-ayes (Daubentonia madagascariensis), and tarsiers.
  • the protein includes no sequences from mice or rabbits (e.g., is not a murine or rabbit antibody).
  • MMP-9/2 binding protein Any MMP-9/2 binding protein may be used in the methods and compositions for treating inflammatory disorders that are disclosed herein.
  • MMP-9/2 binding proteins are binding proteins that bind to MMP-9 (e.g., human MMP-9) and MMP-2 (e.g., human MMP-2) and are either peptides, polypeptides that nclude at least one immunoglobin variable region, or Kunitz domains. Methods for discovering and selecting and improving such binding proteins are described further below.
  • the MMP-9/2 binding protein includes at least one immunoglobin variable region.
  • the MMP-9/MMP-2 binding protein includes a heavy chain (HC) immunoglobulin variable domain sequence and a light chain (LC) immunoglobulin variable domain sequence.
  • HC heavy chain
  • LC light chain
  • MMP-9/MMP-2 binding proteins may be antibodies.
  • MMP-9/MMP-2 binding antibodies may have their HC and LC variable domain sequences included in a single polypeptide (e.g., scFv), or on different polypeptides (e.g., IgG or Fab).
  • the MMP-9/MMP-2 binding protein may be an isolated protein (e.g., at least 70, 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, or 99% free of other proteins).
  • the MMP-9/MMP-2 binding protein may additionally inhibit MMP-9, e.g., human MMP-9 and/or MMP-2, e.g., human MMP-2.
  • the binding protein can inhibit the catalytic activity of MMP-9 (e.g., human MMP-9) and/or MMP-2 (e.g., human MMP-2).
  • the protein binds the catalytic domain of human MMP-9, e.g., the protein contacts residues in or near the active site of MMP-9 and/or the protein binds the catalytic domain of human MMP-2, e.g., the protein contacts residues in or near the active site of MMP-2.
  • the protein does not contact residues in or near the active site of MMP-9 but instead binds elsewhere on MMP-9 and causes a steric change in MMP-9 that affects (e.g., inhibits) its activity. In other embodiments, the protein does not contact residues in or near the active site of MMP-2 but instead binds elsewhere on MMP-2 and causes a steric change in MMP-2 that affects (e.g., inhibits) its activity.
  • the protein can bind to MMP-9 and/or MMP-2 with a binding affinity of at least 10 5 , 10 6 , 10 7 ,10 8 , 10 9 , 10 10 and 10 11 M -1 .
  • the protein binds to MMP-9 and/or MMP-2 with a K off slower than 1 X 10 ⁇ 3 , 5 X 10 ⁇ 4 s -1 , or 1 X 10 ⁇ 4 s -1 .
  • the protein binds to MMP-12 with a K 0n faster than 1 X 10 2 , 1 X 10 3 , or 5 X 10 3 M- V 1 .
  • the protein inhibits human MMP-9 and/or MMP-2 activity, e.g., with a Ki of less than 10 ⁇ 5 , 10 ⁇ 6 , 10 ⁇ 7 , 10 ⁇ 8 , 10 ⁇ 9 , and 10 ⁇ 10 M.
  • the protein can have, for example, an IC50 of less than 100 nM, 10 nM or 1 nM. In some embodiments, the protein has an IC50 of about 1.8 nM.
  • the affinity of the protein for MMP-9 can be characterized by a K D of less than 100 nm, less than 10 nM, or about 3 nM (e.g., 3.1 nM), about 5 nM (e.g., 5 nM), about 6 nm (e.g., 5.9 nM), about 7 nM (e.g., 7.1 nM), or about 10 nM (e.g., 9.6 nM).
  • K D K D of less than 100 nm, less than 10 nM, or about 3 nM (e.g., 3.1 nM), about 5 nM (e.g., 5 nM), about 6 nm (e.g., 5.9 nM), about 7 nM (e.g., 7.1 nM), or about 10 nM (e.g., 9.6 nM).
  • the protein has a K D ⁇ 200 nM.
  • the protein has a tl/2 of at least about 10 minutes (e.g., 11 minutes), at least about 20 minutes (e.g., 18 minutes), at least about 25 minutes (e.g., 25 minutes), at least about 35 minutes (e.g., 33 minutes), or at least about 60 minutes (e.g., 57 minutes).
  • An exemplary MMP-9/2 binding protein includes an antibody with a heavy chain (HC) and/or light chain (LC), and in some embodiments, an HC and/or LC variable domain, that is selected from the group of antibodies consisting of: M0237-D02, X0106-A01, X0106-B02, X0106-C04, X0106-E4, and X0106-F05.
  • HC heavy chain
  • LC light chain
  • An exemplary MMP- 14 binding protein includes an antibody with a heavy chain (HC) and/or light chain (LC), and in some embodiments, three HC and/or three LC CDRs, that are selected from the group of antibodies consisting of: M0237-D02, XOl 06- AOl, X0106-B02, X0106- C04, X0106-E4, and X0106-F05.
  • HC heavy chain
  • LC light chain
  • MMP-9/2 binding proteins are further described in USSN 61/033,075, filed March 3, 2008 and USSN 61/054,938, filed May 21, 2008, and WO 2009/111508.
  • the HC and LC variable domain sequences are components of the same polypeptide chain. In another, the HC and LC variable domain sequences are components of different polypeptide chains.
  • the protein is an IgG, e.g., IgGl, IgG2, IgG3, or IgG4.
  • the protein can be a soluble Fab (sFab).
  • the protein includes a Fab2', scFv, minibody, scFv::Fc fusion, Fab::HSA fusion, HSA::Fab fusion, Fab::HSA::Fab fusion, or other molecule that comprises the antigen combining site of one of the binding proteins herein.
  • VH and VL regions of these Fabs can be provided as IgG, Fab, Fab2, Fab2', scFv, PEGylated Fab, PEGylated scFv, PEGylated Fab2, VH::CH1::HSA+LC, HSA::VH::CH1+LC, LC::HSA + VH::CH1, HSA::LC + VH::: CHl, or other appropriate construction.
  • the protein is a human or humanized antibody or is non-immunogenic in a human.
  • the protein includes one or more human antibody framework regions, e.g., all human framework regions.
  • the protein includes a human Fc domain, or an Fc domain that is at least 95, 96, 97, 98, or 99% identical to a human Fc domain.
  • the protein is a primate or primatized antibody or is non-immunogenic in a human.
  • the protein includes one or more primate antibody framework regions, e.g., all primate framework regions.
  • the protein includes a primate Fc domain, or an Fc domain that is at least 95, 96, 97, 98, or 99% identical to a primate Fc domain.
  • "Primate” includes humans ⁇ Homo sapiens), chimpanzees ⁇ Pan troglodytes and Pan paniscus (bonobos)), gorillas ⁇ Gorilla gorilla), gibons, monkeys, lemurs, aye-ayes (Daubentonia madagascariensis), and tarsiers.
  • the protein includes no sequences from mice or rabbits (e.g., is not a murine or rabbit antibody).
  • Any MMP-12 binding protein may be used in the methods and compositions for treating inflammatory disorders that are disclosed herein.
  • MMP-12 is encoded by a gene designated as MMP12 with full name Matrix metalloproteinase- 12 precursor. Synonyms for MMP-12 include matrix metalloproteinase 12, macrophage elastase, macrophage metalloelastase.
  • the DNA sequence is known for Homo sapiens and Mus musculus.
  • An exemplary cDNA sequence encoding human MMP12 and the amino acid sequence are shown below.
  • Exemplary cDNA sequences encoding murine MMP12 and amino acid sequences are also shown below.
  • An exemplary MMP-12 protein can include the human or mouse MMP-12 amino acid sequence, a sequence that is 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identical to one of these sequences, or a fragment thereof, e.g., a fragment without the signal sequence or prodomain.
  • cDNA and amino acid sequences of human MMP12 can include the human or mouse MMP-12 amino acid sequence, a sequence that is 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identical to one of these sequences, or a fragment thereof, e.g., a fragment without the signal sequence or prodomain.
  • MMP- 12 Factors that regulate MMP- 12. Expression of MMP- 12 is regulated by many factors. Reports of upregulation include: Oncogene. 2004 Jan 22;23(3):845-51. (recurrence in stage I lung cancer, 2/10 cases), Ann Neurol. 2003 Jun;53(6):731-42. (collagenase-induced rat model of intracerebral hemorrhage), Cancer Res. 2005 May 15;65(10):4261-72. (protein kinase C/p53 resistant cells), Br J Dermatol. 2005 Apr;152(4):720-6. (Samples from nine patients with squamous cell carcinoma), Cardiovasc Res. 2005 May l;66(2):410-9. (Aging), J Immunol.
  • MMP-12 has a number of endogenous inhibitors. Like other MMPs, MMP-12 is inhibited by TIMPs (Murphy, G., and Willenbrock, F. (1995) Methods Enzymol. 248, 496-510).
  • Small molecule inhibitors of MMP-12 Small molecule inhibitors of MMP-12. Small molecule inhibitors of MMP-12 have been synthesized and tested. Most of these have either insufficient potency or insufficient specificity, or both. The reports include: Proc Natl Acad Sci USA. 2005 Apr 12;102(15):5334-9. (acetohydroxamic acid and N-isobutyl-N-[4-methoxyphenylsulfonyl]glycyl hydroxamic acid); Arthritis Rheum. 2004 Oct;50(10):3275-85. (a general hydroxamate inhibitor of MMP activity); Arch Biochem Biophys. 2003 Jan 15;409(2):335-40. (peptide Iin24); J MoI Biol.
  • Small interfering RNA inhibitors of MMP-12 can be inhibited by small interfering RNA (siRNA).
  • siRNA small interfering RNA
  • Examples of siRNA that can be used are described in US Patent Publication No.: 20040087533 and PCt Publication No.: WO 200409098.
  • the siRNA can be administered to inhibit MMP-12, e.g., in combination with a MMP-12 binding protein described herein.
  • proteins that bind to MMP-12 e.g., human MMP-12
  • MMP-12 e.g., human MMP-12
  • proteins that bind to MMP-12 are either peptides, polypeptides that include at least one immunoglobin variable region, or Kunitz domains. Methods for discovering and selecting and improving such binding proteins are described further below.
  • proteins that bind to MMP-12 include at least one immunoglobin variable region.
  • the MMP-12 binding protein includes a heavy chain (HC) immunoglobulin variable domain sequence and a light chain (LC) immunoglobulin variable domain sequence.
  • HC heavy chain
  • LC light chain
  • the MMP-12 binding protein may be an isolated protein (e.g., at least 70, 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, or 99% free of other proteins).
  • the MMP-12 binding protein may additionally inhibit MMP-12, e.g., human and/or murine MMP-12.
  • the binding protein can inhibit the catalytic activity of MMP-12 (e.g., human MMP-12).
  • the protein binds the catalytic domain of human MMP-12, e.g., the protein contacts residues in or near the active site of MMP-12.
  • the protein does not contact residues in or near the active site of MMP-12 but instead binds elsewhere on MMP-12 and causes a steric change in MMP-12 that affects (e.g., inhibits) its activity.
  • the protein can bind to MMP-12, e.g., human MMP-12, with a binding affinity of at least 10 5 , 10 6 , 10 7 ,10 8 , 10 9 , 10 10 and 10 11 M -1 .
  • the protein binds to MMP-12 with a K off slower than 1 X 10 -3 , 5 X 10 -4 s -1 , or 1 X 10 -4 s -1 .
  • the protein binds to MMP-12 with a K 0n faster than 1 x 10 , 1 x 10 , or 5x 10 M s- .
  • the protein inhibits human MMP-12 activity, e.g., with a Ki of less than 10 -5 , 10 -6 , 10 -7 , 10 -8 , 10 -9 , and 10 -10 M.
  • the protein can have, for example, an IC50 of less than 100 nM, 10 nM or 1 nM. In some embodiments, the protein has an IC50 of about 1.8 nM.
  • the affinity of the protein for MMP-12 can be characterized by a K D of less than 100 nm, less than 10 nM, or about 3 nM (e.g., 3.1 nM), about 5 nM (e.g., 5 nM), about 6 nm (e.g., 5.9 nM), about 7 nM (e.g., 7.1 nM), or about 10 nM (e.g., 9.6 nM).
  • K D K D of less than 100 nm, less than 10 nM, or about 3 nM (e.g., 3.1 nM), about 5 nM (e.g., 5 nM), about 6 nm (e.g., 5.9 nM), about 7 nM (e.g., 7.1 nM), or about 10 nM (e.g., 9.6 nM).
  • the protein has a K D ⁇ 200 nM.
  • the protein has a tl/2 of at least about 10 minutes (e.g., 11 minutes), at least about 20 minutes (e.g., 18 minutes), at least about 25 minutes (e.g., 25 minutes), at least about 35 minutes (e.g., 33 minutes), or at least about 60 minutes (e.g., 57 minutes).
  • the protein binds the catalytic domain of human MMP- 12, e.g., the protein contacts residues in or near the active site of MMP- 12.
  • the protein does not contact residues in or near the active site of MMP- 12 but instead binds elsewhere on MMP-12 and causes a steric change in MMP-12 that affects (e.g., inhibits) its activity.
  • the protein is a human antibody having the light and heavy chains of antibodies selected from the group consisting of DX-2712, a mutant or variant of DX-2712 (e.g., as described in WO 2009/111507), 539B-X0041-D02, M0134-A02, M134-A05, M134-A07, M134-A09, M134-A10, M134-A11, M0134-B01, M134-B04, M0134-B08, M0134-B11, M0134-C01, M0134- C02, M0134-C06, M0134-C09, M0134-C10, M0134-C11, M0134-C12, M0134-D02, M0134-DO3, M0134-E04, M0134-E07, M0134-E08, M134-E11, M0134-F01, M0134-F05, M0134-G02, M0134- G04, M01
  • the protein is a human antibody having its heavy chain selected from the group consisting of DX-2712, a mutant or variant of DX- 2712 (e.g., as described in WO 2009/111507), 539B-X0041-D02, M0134-A02, M134-A05, M134- A07, M134-A09, M134-A10, M134-A11, M0134-B01, M134-B04, M0134-B08, M0134-B11, M0134-C01, M0134-C02, M0134-C06, M0134-C09, M0134-C10, M0134-C11, M0134-C12, M0134- D02, M0134-DO3, M0134-E04, M0134-E07, M0134-E08, M134-E11, M0134-F01, M0134-F05, M0134-G02, M0134-G04, M0134-G07
  • the protein is a human antibody having its light chain selected from the group consisting of DX-2712, a mutant or variant of DX-2712 (e.g., as described in WO 2009/111507), 539B-X0041- D02, M0134-A02, M134-A05, M134-A07, M134-A09, M134-A10, M134-A11, M0134-B01, M134- B04, M0134-B08, M0134-B11, M0134-C01, M0134-C02, M0134-C06, M0134-C09, M0134-C10, M0134-C11, M0134-C12, M0134-D02, M0134-DO3, M0134-E04, M0134-E07, M0134-E08, M134- EIl, M0134-F01, M0134-F05, M0134-G02, M0134-G04, M0134-G
  • the protein is a human antibody having one or more heavy chain CDRs picked from the corresponding CDRs of the heavy chains selected from the group consisting of DX-2712, a mutant or variant of DX-2712 (e.g., as described in WO 2009/111507), 539B-X0041-D02, M0134- A02, M134-A05, M134-A07, M134-A09, M134-A10, M134-A11, M0134-B01, M134-B04, M0134- B08, M0134-B11, M0134-C01, M0134-C02, M0134-C06, M0134-C09, M0134-C10, M0134-C11, M0134-C12, M0134-D02, M0134-DO3, M0134-E04, M0134-E07, M0134-E08, M134-E11, M0134- FOl, M0134-F05, M0134
  • the protein is a human antibody having one or more light chain CDRs picked from the corresponding CDRs of the light chains selected from the group consisting of DX-2712, a mutant or variant of DX-2712 (e.g., as described in WO 2009/111507), 539B-X0041-D02, M0134-A02, M134- A05, M134-A07, M134-A09, M134-A10, M134-A11, M0134-B01, M134-B04, M0134-B08, M0134- BI l, M0134-C01, M0134-C02, M0134-C06, M0134-C09, M0134-C10, M0134-C11, M0134-C12, M0134-D02, M0134-DO3, M0134-E04, M0134-E07, M0134-E08, M134-E11, M0134-F01, M0134- F05, M
  • the protein is a human antibody having one or more light chain CDRs and one or more heavy chain CDRs picked from the corresponding CDRs of the light chains selected from the group consisting of DX-2712, a mutant or variant of DX-2712 (e.g., as described in WO 2009/111507), 539B-X0041-D02, M0134-A02, M134-A05, M134-A07, M134-A09, M134-A10, M134-A11, M0134- BOl, M134-B04, M0134-B08, M0134-B11, M0134-C01, M0134-C02, M0134-C06, M0134-C09, M0134-C10, M0134-C11, M0134-C12, M0134-D02, M0134-DO3, M0134-E04, M0134-E07, M0134- E08, M134-E11, M0134-F01, M
  • MMP-12 binding proteins are further described in USSN 61/033,348, filed March 3, 2008 and USSN 61/127,830, filed May 14, 2008, and WO 2009/111507.
  • the protein is a human antibody having the light and heavy chains of antibodies DX-2712, M0008-H09, M0131-A06 or M0121-E07.
  • the protein is a human antibody having its heavy chain from DX-2712, M0008-H09, M0131-A06 and M0121-E07.
  • the protein is a human antibody having its light chain from DX-2712, M0008-H09, M0131-A06 or M0121-E07.
  • the protein is a human antibody having one or more heavy chain CDRs from the corresponding CDRs of the heavy chain of DX-2712, M0008-H09, M0131-A06 or M0121-E07. In another even more preferred embodiment, the protein is a human antibody having one or more light chain CDRs from the corresponding CDRs of the light chain of DX-2712, M0008-H09, M0131-A06 or M0121-E07.
  • the HC and LC variable domain sequences are components of the same polypeptide chain. In another, the HC and LC variable domain sequences are components of different polypeptide chains.
  • the protein is an IgG, e.g., IgGl, IgG2, IgG3, or IgG4.
  • the protein can be a soluble Fab (sFab).
  • the protein includes a Fab2', scFv, minibody, scFv::Fc fusion, Fab::HSA fusion, HSA::Fab fusion, Fab::HSA::Fab fusion, or other molecule that comprises the antigen combining site of one of the binding proteins herein.
  • VH and VL regions of these Fabs can be provided as IgG, Fab, Fab2, Fab2', scFv, PEGylated Fab, PEGylated scFv, PEGylated Fab2, VH::CH1::HSA+LC, HSA::VH::CH1+LC, LC::HSA + VH::CH1, HSA::LC + VH::: CHl, or other appropriate construction.
  • the protein is a human or humanized antibody or is non-immunogenic in a human.
  • the protein includes one or more human antibody framework regions, e.g., all human framework regions.
  • the protein includes a human Fc domain, or an Fc domain that is at least 95, 96, 97, 98, or 99% identical to a human Fc domain.
  • the protein is a primate or primatized antibody or is non-immunogenic in a human.
  • the protein includes one or more primate antibody framework regions, e.g., all primate framework regions.
  • the protein includes a primate Fc domain, or an Fc domain that is at least 95, 96, 97, 98, or 99% identical to a primate Fc domain.
  • "Primate” includes humans ⁇ Homo sapiens), chimpanzees ⁇ Pan troglodytes and Pan paniscus (bonobos)), gorillas ⁇ Gorilla gorilla), gibons, monkeys, lemurs, aye-ayes (Daubentonia madagascariensis), and tarsiers.
  • the protein includes no sequences from mice or rabbits (e.g., is not a murine or rabbit antibody). MMP-14 Binding. Proteins
  • Any MMP-14 binding protein may be used in the methods and compositions for treating inflammatory disorders that are disclosed herein.
  • MMP-14 is encoded by a gene designated as MMP 14, matrix metalloproteinase-14 precursor. Synonyms for MMP-14 include matrix metalloproteinase 14 (membrane-inserted), membrane-type- 1 matrix metalloproteinase, membrane-type matrix metalloproteinase 1, MMP-14, MMP-Xl, MTlMMP, MTl-MMP, MTMMPl, MT-MMP 1.
  • MT-MMPs have similar structures, including a signal peptide, a prodomain, a catalytic domain, a hinge region, and a hemopexin domain (Wang, et al., 2004, J Biol Chem, 279:51148-55).
  • the signal sequence of MMP-14 precursor includes amino acid residues 1-20.
  • the pro-peptide includes residues 21-111. Cys93 is annotated as a possible cysteine switch.
  • Residues 112 through 582 make up the mature, active protein.
  • the catalytic domain includes residues 112-317.
  • the hemopexin domains includes residues 318-523.
  • the transmembrane segment comprises residues 542 through 562.
  • MMP-14 can be shed from cells or found on the surface of cells, tethered by a single transmembrane amino-acid sequence. See, e.g., Osnkowski et al. (2004, J Cell Physiol, 200:2-10).
  • mice MMP 14 An exemplary amino acid sequence of mouse MMP 14 is shown in Table 5.
  • Table 5 Amino-acid sequence of mouse MMP14
  • GenBank Accession No. NP_032634.2 GenBank Accession No. NP_032634.2.
  • An exemplary MMP- 14 protein against which MMP 14 binding proteins may be developed can include the human or mouse MMP-14 amino acid sequence, a sequence that is 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% identical to one of these sequences, or a fragment thereof, e.g., a fragment without the signal sequence or prodomain.
  • proteins that bind to MMP-14 are either peptides, polypeptides that include at least one immunoglobin variable region, or Kunitz domains. Methods for discovering and selecting and improving such binding proteins are described further below.
  • the MMP-14 binding protein may be an isolated protein (e.g., at least 70, 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, or 99% free of other proteins).
  • the MMP-14 binding protein may additionally inhibit MMP-14, e.g., human and/or murine MMP-14.
  • the binding protein can inhibit the catalytic activity of MMP-14 (e.g., human MMP-14).
  • the protein binds the catalytic domain of human MMP-14, e.g., the protein contacts residues in or near the active site of MMP-14.
  • the protein does not contact residues in or near the active site of MMP-14 but instead binds elsewhere on MMP-14 and causes a steric change in MMP-14 that affects (e.g., inhibits) its activity.
  • proteins that bind to MMP-14 e.g., human MMP-14 and include at least one immunoglobulin variable region are used in the methods and compositions.
  • the MMP-14 binding protein includes a heavy chain (HC) immunoglobulin variable domain sequence and a light chain (LC) immunoglobulin variable domain sequence.
  • HC heavy chain
  • LC light chain
  • the protein can bind to MMP-14 with a binding affinity of at least 10 5 , 10 6 , 10 7 ,10 8 , 10 9 , 10 10 and 10 11 M -1 .
  • the protein binds to MMP-14 with a K off slower than 1 X 10 -3 , 5 X 10- 4 s -1 , or 1 x 10 ⁇ 4 s -1 .
  • the protein binds to MMP-14 with a K 0n faster than 1 X 10 2 , 1 X 10 3 , or 5 X 10 3 M 1 S 1 .
  • the protein inhibits human MMP-14 activity, e.g., with a Ki of less than 10 -5 , 10 -6 , 10 -7 , 10 -8 , 10 -9 , and 10 -10 M.
  • the protein can have, for example, an IC50 of less than 100 nM, 10 nM or 1 nM. In some embodiments, the protein has an IC50 of about 1.8 nM.
  • the affinity of the protein for MMP- 14 can be characterized by a K D of less than 100 nm, less than 10 nM, or about 3 nM (e.g., 3.1 nM), about 5 nM (e.g., 5 nM), about 6 nm (e.g., 5.9 nM), about 7 nM (e.g., 7.1 nM), or about 10 nM (e.g., 9.6 nM).
  • K D K D of less than 100 nm, less than 10 nM, or about 3 nM (e.g., 3.1 nM), about 5 nM (e.g., 5 nM), about 6 nm (e.g., 5.9 nM), about 7 nM (e.g., 7.1 nM), or about 10 nM (e.g., 9.6 nM).
  • the protein has a K D ⁇ 200 nM.
  • the protein has a tl/2 of at least about 10 minutes (e.g., 11 minutes), at least about 20 minutes (e.g., 18 minutes), at least about 25 minutes (e.g., 25 minutes), at least about 35 minutes (e.g., 33 minutes), or at least about 60 minutes (e.g., 57 minutes).
  • MMP-14 binding proteins may also be antibodies.
  • MMP-14 binding antibodies may have their HC and LC variable domain sequences included in a single polypeptide (e.g., scFv), or on different polypeptides (e.g., IgG or Fab).
  • An exemplary MMP-14 binding protein includes an antibody with a heavy chain (HC) and/or light chain (LC), and in some embodiments, an HC and/or LC variable domain, that is selected from the group of antibodies consisting of: DX-2400, DX-2410, M0031-C02, M0031-F01, M0033-H07, M0037-C09, M0037-D01, M0038-E06, M0038-F01, M0038-F08, M0039-H08, M0040-A06, M0040- Al 1, and M0043-G02.
  • An exemplary MMP-14 binding protein includes an antibody with a heavy chain (HC) and/or light chain (LC), and in some embodiments, three HC and/or three LC CDRs, that are selected from the group of antibodies consisting of: DX-2400, DX-2410, M0031-C02, M0031- FOl, M0033-H07, M0037-C09, M0037-D01, M0038-E06, M0038-F01, M0038-F08, M0039-H08, M0040-A06, M0040-A11, and M0043-G02. Further description of them and their discovery and production is provided in pending application USSN 11/648,423 (US 2007-0217997) and WO 2007/079218.
  • HC heavy chain
  • LC light chain
  • the MMP-14 binding protein comprises one or moe (e.g., 1, 2, or 3) HC CDRs and/or one or more (e.g., 1, 2, or 3) LC CDRs of DX-2400.
  • the MMP-14 binding protein comprises the HC variable region and/or the LC variable region of DX-2400.
  • the MMP-14 binding protein comprises one or moe (e.g., 1, 2, or 3) HC CDRs and/or one or more (e.g., 1, 2, or 3) LC CDRs of DX-2410.
  • the MMP-14 binding protein comprises the HC variable region and/or the LC variable region of DX-2410.
  • the HC and LC variable domain sequences are components of the same polypeptide chain. In another, the HC and LC variable domain sequences are components of different polypeptide chains.
  • the protein is an IgG, e.g., IgGl, IgG2, IgG3, or IgG4.
  • the protein can be a soluble Fab (sFab).
  • the protein includes a Fab2', scFv, minibody, scFv::Fc fusion, Fab::HSA fusion, HSA::Fab fusion, Fab::HSA::Fab fusion, or other molecule that comprises the antigen combining site of one of the binding proteins herein.
  • VH and VL regions of these Fabs can be provided as IgG, Fab, Fab2, Fab2', scFv, PEGylated Fab, PEGylated scFv, PEGylated Fab2, VH::CH1::HSA+LC, HSA::VH::CH1+LC, LC::HSA + VH::CH1, HSA::LC + VH::: CHl, or other appropriate construction.
  • the protein is a human or humanized antibody or is non-immunogenic in a human.
  • the protein includes one or more human antibody framework regions, e.g., all human framework regions.
  • the protein includes a human Fc domain, or an Fc domain that is at least 95, 96, 97, 98, or 99% identical to a human Fc domain.
  • the protein is a primate or primatized antibody or is non-immunogenic in a human.
  • the protein includes one or more primate antibody framework regions, e.g., all primate framework regions.
  • the protein includes a primate Fc domain, or an Fc domain that is at least 95, 96, 97, 98, or 99% identical to a primate Fc domain.
  • "Primate” includes humans ⁇ Homo sapiens), chimpanzees ⁇ Pan troglodytes and Pan paniscus (bonobos)), gorillas ⁇ Gorilla gorilla), gibons, monkeys, lemurs, aye-ayes (Daubentonia madagascariensis), and tarsiers.
  • the protein includes no sequences from mice or rabbits (e.g., is not a murine or rabbit antibody).
  • MMP- 14 inhibitors known in the art include, but are not limited to, those disclosed in the following patents and patent applications: U.S. 6,114,159; U.S. 6,399,348; JP 3802560 and EP 0750672 (all in the name of Max Delbrueck Center for Molecular Medicine); U.S. 6,184,022; U.S. 6,825,024; EP 0685557; JP 2694604 (all in the name of Daiichi Fine Chemicals); and USSN 11/648,423 (US 2007-0217997) and WO 2007/079218.
  • Protease binding proteins may be discovered by any method of ligand discovery known in the art.
  • protease binding proteins may be discovered by screening a library.
  • the library is a display library.
  • a display library is a collection of entities; each entity includes an accessible polypeptide component and a recoverable component that encodes or identifies the polypeptide component.
  • the polypeptide component is varied so that different amino acid sequences are represented.
  • the polypeptide component can be of any length, e.g. from three amino acids to over 300 amino acids.
  • a display library entity can include more than one polypeptide component, for example, the two polypeptide chains of a sFab.
  • a display library can be used to identify proteins that bind to an protease of interest.
  • the polypeptide component of each member of the library is probed with the protease of interest (e.g., a catalytic domain of an MMP or other fragment) and if the polypeptide component binds to the protease, the display library member is identified, typically by retention on a support.
  • the display library comprises antibodies.
  • the display library comprises Kunitz domains.
  • the display library comprises peptides.
  • each candidate library member can be further analyzed, e.g., to further characterize its binding properties for the target, e.g., the protease of interest, or for binding to other protein, e.g., another metalloproteinase.
  • Each candidate library member can be subjected to one or more secondary screening assays.
  • the assay can be for a binding property, a catalytic property, an inhibitory property, a physiological property (e.g., cytotoxicity, renal clearance, immunogenicity), a structural property (e.g., stability, conformation, oligomerization state) or another functional property.
  • the same assay can be used repeatedly, but with varying conditions, e.g., to determine pH, ionic, or thermal sensitivities.
  • the assays can use a display library member directly, a recombinant polypeptide produced from the nucleic acid encoding the selected polypeptide, or a synthetic peptide synthesized based on the sequence of the selected polypeptide.
  • the Fabs can be evaluated or can be modified and produced as intact IgG proteins.
  • Exemplary assays for binding properties include ELISAs, homogenous binding assays, surface plasmon resonance (SPR) and cellular assays, the practice of which are well-known to those of skill in the art.
  • protease binding antibody In addition to the use of display libraries, other methods can be used to obtain an protease binding antibody.
  • a protease or a region thereof can be used as an antigen in a non- human animal, e.g., a rodent.
  • Humanized antibodies can be generated by replacing sequences of the Fv variable region that are not directly involved in antigen binding with equivalent sequences from human Fv variable regions.
  • General methods for generating humanized antibodies are provided by Morrison, S. L., 1985, Science 229:1202-1207, by Oi et al., 1986, BioTechniques 4:214, and by Queen et al. US Patent Nos. 5,585,089, US 5,693,761 and US 5,693,762.
  • nucleic acids may be obtained from a hybridoma producing an antibody against a predetermined target, as described above. The recombinant DNA encoding the humanized antibody, or fragment thereof, can then be cloned into an appropriate expression vector.
  • Immunoglobin protease binding proteins may be modified to reduce immunogenicity. Reduced immunogenicity is desirable in protease binding proteins intended for use as therapeutics, as it reduces the chance that the subject will develop an immune response against the therapeutic molecule. Techniques useful for reducing immunogenicity of protease binding proteins include deletion/modification of potential human T cell epitopes and 'germlining' of sequences outside of the CDRs (e.g., framework and Fc).
  • a protease -binding antibody may be modified by specific deletion of human T cell epitopes or "deimmunization" by the methods disclosed in WO 98/52976 and WO 00/34317. Briefly, the heavy and light chain variable regions of an antibody are analyzed for peptides that bind to MHC Class II; these peptides represent potential T-cell epitopes (as defined in WO 98/52976 and WO 00/34317).
  • peptide threading For detection of potential T-cell epitopes, a computer modeling approach termed "peptide threading" can be applied, and in addition a database of human MHC class II binding peptides can be searched for motifs present in the VH and VL sequences, as described in WO 98/52976 and WO 00/34317. These motifs bind to any of the 18 major MHC class II DR allotypes, and thus constitute potential T cell epitopes.
  • Potential T-cell epitopes detected can be eliminated by substituting small numbers of amino acid residues in the variable regions, or preferably, by single amino acid substitutions. As far as possible conservative substitutions are made, often but not exclusively, an amino acid common at this position in human germline antibody sequences may be used.
  • nucleic acids encoding V H and V L can be constructed by mutagenesis or other synthetic methods (e.g., de novo synthesis, cassette replacement, and so forth).
  • Mutagenized variable sequence can, optionally, be fused to a human constant region, e.g., human IgGl or K constant regions.
  • a potential T cell epitope will include residues which are known or predicted to be important for antibody function. For example, potential T cell epitopes are usually biased towards the CDRs. In addition, potential T cell epitopes can occur in framework residues important for antibody structure and binding.
  • the choice of the final deimmunized antibody can then be made by considering the binding affinity of the different variants in conjunction with the extent of deimmunization, i.e., the number of potential T cell epitopes remaining in the variable region.
  • Deimmunization can be used to modify any antibody, e.g., an antibody that includes a non-human sequence, e.g., a synthetic antibody, a murine antibody other non-human monoclonal antibody, or an antibody isolated from a display library.
  • Protease binding antibodies are "germlined" by reverting one or more non-germline amino acids in framework regions to corresponding germline amino acids of the antibody, so long as binding properties are substantially retained. Similar methods can also be used in the constant region, e.g., in constant immunoglobulin domains.
  • Antibodies that bind to a protease, such as MMP may be modified in order to make the variable regions of the antibody more similar to one or more germline sequences.
  • an antibody can include one, two, three, or more amino acid substitutions, e.g., in a framework, CDR, or constant region, to make it more similar to a reference germline sequence.
  • One exemplary germlining method can include identifying one or more germline sequences that are similar (e.g., most similar in a particular database) to the sequence of the isolated antibody.
  • Mutations are then made in the isolated antibody, either incrementally or in combination with other mutations. For example, a nucleic acid library that includes sequences encoding some or all possible germline mutations is made. The mutated antibodies are then evaluated, e.g., to identify an antibody that has one or more additional germline residues relative to the isolated antibody and that is still useful (e.g., has a functional activity). In one embodiment, as many germline residues are introduced into an isolated antibody as possible.
  • mutagenesis is used to substitute or insert one or more germline residues into a framework and/or constant region.
  • a germline framework and/or constant region residue can be from a germline sequence that is similar (e.g., most similar) to the non-variable region being modified.
  • activity e.g., binding or other functional activity
  • Similar mutagenesis can be performed in the framework regions.
  • Selecting a germline sequence can be performed in different ways. For example, a germline sequence can be selected if it meets a predetermined criteria for selectivity or similarity, e.g., at least a certain percentage identity, e.g., at least 75, 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 99.5% identity. The selection can be performed using at least 2, 3, 5, or 10 germline sequences. In the case of CDRl and CDR2, identifying a similar germline sequence can include selecting one such sequence.
  • a predetermined criteria for selectivity or similarity e.g., at least a certain percentage identity, e.g., at least 75, 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 99.5% identity.
  • the selection can be performed using at least 2, 3, 5, or 10 germline sequences.
  • identifying a similar germline sequence can include selecting one
  • identifying a similar germline sequence can include selecting one such sequence, but may including using two germline sequences that separately contribute to the amino-terminal portion and the carboxy-terminal portion. In other implementations more than one or two germline sequences are used, e.g., to form a consensus sequence.
  • a related variable domain sequence has at least 30, 40, 50, 60, 70, 80, 90, 95 or 100% of the CDR amino acid positions that are not identical to residues in the reference CDR sequences, residues that are identical to residues at corresponding positions in a human germline sequence (i.e., an amino acid sequence encoded by a human germline nucleic acid).
  • a related variable domain sequence has at least 30, 50, 60, 70, 80, 90 or 100% of the FR regions identical to FR sequence from a human germline sequence, e.g., a germline sequence related to the reference variable domain sequence.
  • an antibody which has similar activity to a given antibody of interest, but is more similar to one or more germline sequences, particularly one or more human germline sequences.
  • an antibody can be at least 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 99.5% identical to a germline sequence in a region outside the CDRs (e.g., framework regions).
  • an antibody can include at least 1, 2, 3, 4, or 5 germline residues in a CDR region, the germline residue being from a germline sequence of similar (e.g., most similar) to the variable region being modified.
  • Germline sequences of primary interest are human germline sequences.
  • the activity of the antibody e.g., the binding activity as measured by K A
  • Germline sequences of human immunoglobin genes have been determined and are available from a number of sources, including the international ImMunoGeneTics information system® (IMGT), available via the world wide web at imgt.cines.fr, and the V BASE directory (compiled by Tomlinson, LA. et al. MRC Centre for Protein Engineering, Cambridge, UK, available via the world wide web at vbase.mrc-cpe.cam.ac.uk).
  • IMGT international ImMunoGeneTics information system®
  • Exemplary germline reference sequences for V kapPa include: 012/02, 018/08, A20, A30, L14, Ll, L15, L4/18a, L5/L19, L8, L23, L9 ,L24, LI l, L12, Ol l/Ol, A17, Al, A18, A2, A19/A3, A23, A27, Al l, L2/L16, L6, L20, L25, B3, B2, A26/A10, and A14. See, e.g., Tomlinson et al., 1995, EMBO J. 14(18):4628-3.
  • a germline reference sequence for the HC variable domain can be based on a sequence that has particular canonical structures, e.g., 1-3 structures in the Hl and H2 hypervariable loops.
  • the canonical structures of hypervariable loops of an immunoglobulin variable domain can be inferred from its sequence, as described in Chothia et al., 1992, /. MoI. Biol. 227:799-817; Tomlinson et al., 1992, /. MoI. Biol. 227:776-798); and Tomlinson et al., 1995, EMBO J. 14(18):4628-38.
  • Exemplary sequences with a 1-3 structure include: DP-I, DP-8, DP-12, DP-2, DP-25, DP-15, DP-7, DP-4, DP-31, DP-32, DP-33, DP-35, DP-40, 7-2, hv3005, hv3005f3, DP-46, DP-47, DP-58, DP-49, DP-50, DP-51, DP-53, and DP-54.
  • a protease binding protein is physically associated with a moiety that improves its stabilization and/or retention in circulation, e.g., in blood, serum, lymph, or other tissues, e.g., by at least 1.5, 2, 5, 10, or 50 fold.
  • a protease binding protein can be associated with a polymer, e.g., a substantially non-antigenic polymers, such as polyalkylene oxides or polyethylene oxides. Suitable polymers will vary substantially by weight. Polymers having molecular number average weights ranging from about 200 to about 35,000 (or about 1,000 to about 15,000, and 2,000 to about 12,500) can be used.
  • a protease binding protein can be conjugated to a water soluble polymer, e.g., hydrophilic polyvinyl polymers, e.g. polyvinylalcohol and polyvinylpyrrolidone.
  • a water soluble polymer e.g., hydrophilic polyvinyl polymers, e.g. polyvinylalcohol and polyvinylpyrrolidone.
  • a non-limiting list of such polymers include polyalkylene oxide homopolymers such as polyethylene glycol (PEG) or polypropylene glycols, polyoxyethylenated polyols, copolymers thereof and block copolymers thereof, provided that the water solubility of the block copolymers is maintained.
  • a protease binding protein can also be associated with a carrier protein, e.g., a serum albumin, such as a human serum albumin.
  • a carrier protein e.g., a serum albumin, such as a human serum albumin.
  • a translational fusion can be used to associate the carrier protein with the protease binding protein.
  • the protease binding proteins described herein can be conjugated to a drug (e.g., a DMARD, BRM or other immunosuppressive agent).
  • a drug e.g., a DMARD, BRM or other immunosuppressive agent.
  • the conjugates can be used therapeutically or prophylactically, e.g., the binding protein can target the drug, e.g., in vivo, e.g., to a site of disease (e.g., a site of inflammation), e.g., such that the drug affects the site of disease.
  • the binding protein itself has therapeutic or prophylactic efficacy (e.g., the protein can modulate (e.g., antagonize) protease activity, or cause an effect on a cell that expresses a protease).
  • the binding protein-drug conjugate can be used such that the binding protein and drug both contribute (e.g., additively or synergistically) to an effect on protease activity (e.g., a therapeutic effect, e.g., in vivo, e.g., to a site of disease (e.g., a site of undesired inflammation)).
  • the drug and/or binding protein can be, for example, anti-inflammatory, immunosuppressive, etc.
  • the targeted cell is a cancer cell
  • the drug and/or binding protein can prevent or reduce the ability of a tissue to become inflamed.
  • classes of drugs that can be used as the "other member" in addition to the binding protein in the binding protein-drug conjugates described herein are as follows:
  • the drug is an immunosuppressive agent such as gancyclovir, etanercept, cyclosporine, tacrolimus, rapamycin, cyclophosphamide, azathioprine, mycophenolate mofetil, methotrexate, Cortisol, aldosterone, dexamethasone, a cyclooxygenase inhibitor, a 5- lipoxygenase inhibitor, or a leukotriene receptor antagonist. See generally US 2007-0292441; US 2007-0292422; US 2007-0264266; and US 2006-0233794.
  • immunosuppressive agent such as gancyclovir, etanercept, cyclosporine, tacrolimus, rapamycin, cyclophosphamide, azathioprine, mycophenolate mofetil, methotrexate, Cortisol, aldosterone, dexamethasone, a cyclooxygenase inhibitor,
  • an "immunosuppressive agent” may be considered as a member of one of the other classes of drugs below, if that drug or agent has immunosuppressive activity.
  • the drug is a DMARD such as methotrexate, Leflunomide, Sulphasalazine, Gold — parenteral (Myocrisin), Gold — oral (auranofin), antimalarials such as Hydroxychloroquine, Chloroquine phosphate, Chloroquine sulphate, antibiotics such as Minocycline, D-Penicillamine, Azathioprine, Cyclophosphamide, Cyclosporine, Leflunomide/ Arava, TNF- ⁇ inhibitors/anti-TNF agents such as Etanercept (ENBREL®), Adalimumab (HUMIRA®), and Infliximab (REMICADE®).
  • DMARD may be considered as a member of one of the
  • the drug is a BRM such as a TNF- ⁇ inhibitor (Etanercept (ENBREL®), Adalimumab (HUMIRA®), and Infliximab (REMICADE®)), a CTLA4-Ig (Abatacept (ORENCIA®)) or anti-CD20 (RITUXAN®), any monoclonal antibody, interferon, interleukin-2, various types of colony-stimulating factors (CSF, GM-CSF, G-CSF), and Kineret (anakinra, IL-I antagonist).
  • a BRM such as a TNF- ⁇ inhibitor (Etanercept (ENBREL®), Adalimumab (HUMIRA®), and Infliximab (REMICADE®)
  • CTLA4-Ig Abatacept (ORENCIA®)
  • anti-CD20 RITUXAN®
  • any monoclonal antibody any monoclonal antibody
  • interferon interleukin-2
  • the drug is an NSAID such as aspirin, naproxen, ibuprofen, etodolac, or salsalte.
  • the drug is a corticosteroid.
  • a protease binding protein is physically linked to an immunosuppressive drug, DMARD or BRM.
  • a Kunitz domain inhibitor may be added to the C-terminus of a TNF-receptor-Fc fusion (e.g., ENBREL®) or anti-TNF IgG (e.g., HUMIRA® or REMICADE®).
  • An anti-TNF Fab could be linked to a second Fab protease inhibitor at opposite termini of human serum albumin by genetic fusion.
  • the Kunitz domain or Fab inhibitor could be linked to a Fab-PEG (e.g., CIMZIA®) conjugate by chemical modification.
  • Treatments for other inflammatory disorders such as COPD, asthma, MS, systemic sclerosis, inflammatory bowel disease and psoriasis that also may be incorporated into drug conjugates are described further below.
  • the binding proteins described herein can be associated with a drug to form a binding protein- drug conjugate by being linked to the drug directly.
  • the binding protein is directly conjugated to the drug.
  • the binding proteins described herein can be associated with a drug to form a binding protein-drug conjugate by use of a linker region between the drug and the binding protein.
  • the binding protein is conjugated to the drug via a linker.
  • the linker can be cleavable under intracellular conditions, e.g., such that cleavage of the linker releases the drug from the binding protein in the intracellular environment.
  • the cleavable linker is a peptide linker cleavable by an intracellular protease.
  • the peptide linker is a dipeptide linker.
  • the dipeptide linker is a val-cit (vc) linker or a phe-lys (fk) linker.
  • the cleavable linker is hydrolyzable at a pH of less than 5.5.
  • the hydrolyzable linker is a hydrazone linker.
  • the cleavable linker is a disulfide linker.
  • the linker is cleavable by a cleaving agent that is present in the intracellular environment (e.g., within a lysosome or endosome or caveolea).
  • the linker can be, e.g., a peptidyl linker that is cleaved by an intracellular peptidase or protease enzyme, including, but not limited to, a lysosomal or endosomal protease.
  • the peptidyl linker is at least two amino acids long or at least three amino acids long.
  • Cleaving agents can include cathepsins B and D and plasmin, which are known to hydrolyze dipeptide drug derivatives resulting in the release of active drug inside target cells (see, e.g., Dubowchik and Walker Pharm. Therapeutics 83:67-123 (1999)).
  • peptidyl linkers are cleavable by enzymes that are present in targeted cells (e.g., cancer cells).
  • a peptidyl linker that is cleavable by the thiol-dependent protease cathepsin-B, which is highly expressed in cancerous tissue can be used (e.g., a Phe-Leu or a Gly-Phe-Leu-Gly linker).
  • the peptidyl linker cleavable by an intracellular protease is a Val-Cit (vc) linker or a Phe-Lys linker (fk) (see, e.g., U.S. Pat. No. 6,214,345, which describes the synthesis of doxorubicin with the val-cit linker).
  • vc Val-Cit
  • fk Phe-Lys linker
  • a vc linker is used in the binding protein-drug conjugates described herein.
  • a binding protein- vcAFP or a binding protein- vcMMAF conjugate e.g., a MMP binding protein-vcAFP or a MMP binding protein-vcMMAF conjugate
  • MMP binding protein-vcAFP or a MMP binding protein-vcMMAF conjugate is prepared.
  • the cleavable linker is pH-sensitive, i.e., sensitive to hydrolysis at certain pH values.
  • the pH-senstive linker is hydrolyzable under acidic conditions.
  • an acid-labile linker that is hydrolyzable in the lysosome e.g., a hydrazone, semicarbazone, thiosemicarbazone, cis-aconitic amide, orthoester, acetal., ketal., or the like
  • an acid-labile linker that is hydrolyzable in the lysosome e.g., a hydrazone, semicarbazone, thiosemicarbazone, cis-aconitic amide, orthoester, acetal., ketal., or the like
  • the hydrolyzable linker is a thioether linker (such as, e.g., a thioether attached to the therapeutic agent via an acylhydrazone bond (see, e.g., U.S. Pat. No. 5,622,929)).
  • the linker is cleavable under reducing conditions (e.g., a disulfide linker).
  • a disulfide linker e.g., a disulfide linker.
  • disulfide linkers are known in the art, including, for example, those that can be formed using SATA (N-succinimidyl-S-acetylthioacetate), SPDP (N-succinimidyl-3-(2- pyridyldithio)propionate), SPDB (N-succinimidyl-3-(2-pyridyldithio)butyrate) and SMPT (N- succinimidyl-oxycarbonyl-alpha-methyl-alpha-(2-pyridyl-dithio)toluene)- , SPDB and SMPT (See, e.g., Thorpe et al.
  • the linker is a malonate linker (Johnson et al. Anticancer Res. 15:1387-93 (1995)), a maleimidobenzoyl linker (Lau et al. Bioorg-Med-Chem. 3(10):1299-1304 (1995), or a 3'-N-amide analog (Lau et al. Bioorg-Med-Chem. 3(10):1305-12 (1995)).
  • the linker is not substantially sensitive to the extracellular environment.
  • "not substantially sensitive to the extracellular environment" in the context of a linker means that no more than about 20%, typically no more than about 15%, more typically no more than about 10%, and even more typically no more than about 5%, no more than about 3%, or no more than about 1% of the linkers, in a sample of a binding protein-drug conjugate, are cleaved when the binding protein-drug conjugate is present in an extracellular environment (e.g., in plasma).
  • Whether a linker is not substantially sensitive to the extracellular environment can be determined, for example, by incubating independently with plasma both (a) the binding protein-drug conjugate (the "conjugate sample”) and (b) an equal molar amount of unconjugated binding protein or drug (the “control sample”) for a predetermined time period (e.g., 2, 4, 8, 16, or 24 hours) and then comparing the amount of unconjugated binding protein or drug present in the conjugate sample with that present in control sample, as measured, for example, by high performance liquid chromatography.
  • a predetermined time period e.g., 2, 4, 8, 16, or 24 hours
  • the linker promotes cellular internalization. In certain embodiments, the linker promotes cellular internalization when conjugated to the drug (i.e., in the milieu of the linker-drug moiety of the binding protein-drug conjugate described herein). In yet other embodiments, the linker promotes cellular internalization when conjugated to both the drug and the binding protein.
  • linkers that can be used with the present compositions and methods are described in WO 2004/010957.
  • the binding protein-drug conjugates described herein are used therapeutically in the treatment of an inflammatory disorder.
  • it is desirable to only target a binding protein-drug conjugate to a cell that expresses the target to which the protease binding protein binds e.g., to only target a MMP expressing cell to which a MMP binding protein binds, and not target a nearby "bystander" cell), e.g., to minimize toxicity.
  • it is desirable to target a binding protein-drug conjugate to a cell expressing the target to which the binding protein binds and also to bystander cells e.g., to elicit a "bystander effect").
  • a protease binding protein (e.g., an MMP binding protein, an antibody) is conjugated to the cytotoxic agent via a linker.
  • the linker is cleavable under intracellular conditions, e.g., the cleavable linker is a peptide linker cleavable by an intracellular protease.
  • the linker is a peptide linker, e.g., a dipeptide linker, e.g., a val-cit linker or a phe-lys linker.
  • the cleavable linker is hydrolyzable at a pH of less than 5.5, e.g., the hydrolyzable linker is a hydrazone linker. In another embodiment, the cleavable linker is a disulfide linker.
  • a desired protease inhibitor drug e.g., an MMP binding protein
  • an immunosuppressive drug DMARD or BRM.
  • a Kunitz domain inhibitor could be added to the C-terminus of a TNF-receptor-Fc fusion (eg Enbrel) or anti-TNF IgG (e.g., HUMIRA® or REMICADE®).
  • An anti-TNF Fab could be linked to a second Fab protease inhibitor at opposite termini of human serum albumin by genetic fusion.
  • the Kunitz domain or Fab inhibitor could be linked to a Fab-PEG (e.g., CIMZIA®) conjugate by chemical modification.
  • compositions e.g., pharmaceutically acceptable compositions or pharmaceutical compositions, which include a protease binding protein, particularly a MMP binding protein, e.g., an antibody molecule, other polypeptide or peptide identified as binding to an MMP described herein.
  • the protease binding protein can be formulated together with a pharmaceutically acceptable carrier.
  • Pharmaceutical compositions include therapeutic compositions and diagnostic compositions, e.g., compositions that include labeled protease binding proteins for in vivo imaging.
  • a pharmaceutically acceptable carrier includes any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents, and the like that are physiologically compatible.
  • the carrier is suitable for intravenous, intramuscular, subcutaneous, parenteral, spinal, or epidermal administration (e.g., by injection or infusion), although carriers suitable for inhalation and intranasal administration are also contemplated.
  • the protease binding protein may be coated in a material to protect the compound from the action of acids and other natural conditions that may inactivate the compound.
  • a pharmaceutically acceptable salt is a salt that retains the desired biological activity of the parent compound and does not impart any undesired toxicological effects (see e.g., Berge, S.M., et al., 1977, J. Pharm. Sci. 66:1-19).
  • Examples of such salts include acid addition salts and base addition salts.
  • Acid addition salts include those derived from nontoxic inorganic acids, such as hydrochloric, nitric, phosphoric, sulfuric, hydrobromic, hydroiodic, phosphorous, and the like, as well as from nontoxic organic acids such as aliphatic mono- and dicarboxylic acids, phenyl-substituted alkanoic acids, hydroxy alkanoic acids, aromatic acids, aliphatic and aromatic sulfonic acids, and the like.
  • nontoxic inorganic acids such as hydrochloric, nitric, phosphoric, sulfuric, hydrobromic, hydroiodic, phosphorous, and the like
  • nontoxic organic acids such as aliphatic mono- and dicarboxylic acids, phenyl-substituted alkanoic acids, hydroxy alkanoic acids, aromatic acids, aliphatic and aromatic sulfonic acids, and the like.
  • Base addition salts include those derived from alkaline earth metals, such as sodium, potassium, magnesium, calcium, and the like, as well as from nontoxic organic amines, such as N,N'- dibenzylethylenediamine, N-methylglucamine, chloroprocaine, choline, diethanolamine, ethylenediamine, procaine, and the like.
  • compositions may be in a variety of forms. These include, for example, liquid, semi-solid and solid dosage forms, such as liquid solutions (e.g., injectable and infusible solutions), dispersions or suspensions, tablets, pills, powders, liposomes and suppositories.
  • liquid solutions e.g., injectable and infusible solutions
  • dispersions or suspensions tablets, pills, powders, liposomes and suppositories.
  • the form can depend on the intended mode of administration and therapeutic application.
  • Many compositions are in the form of injectable or infusible solutions, such as compositions similar to those used for administration of humans with antibodies.
  • An exemplary mode of administration is parenteral (e.g., intravenous, subcutaneous, intraperitoneal, intramuscular).
  • the protease binding protein is administered by intravenous infusion or injection.
  • the protease binding protein is administered by intramuscular or subcutaneous injection.
  • the composition can be formulated as a solution, microemulsion, dispersion, liposome, or other ordered structure suitable to high drug concentration.
  • Sterile injectable solutions can be prepared by incorporating the binding protein in the required amount in an appropriate solvent with one or a combination of ingredients enumerated above, as required, followed by filtered sterilization.
  • dispersions are prepared by incorporating the active compound into a sterile vehicle that contains a basic dispersion medium and the required other ingredients from those enumerated above.
  • the preferred methods of preparation are vacuum drying and freeze-drying that yields a powder of the active ingredient plus any additional desired ingredient from a previously sterile-filtered solution thereof.
  • the proper fluidity of a solution can be maintained, for example, by the use of a coating such as lecithin, by the maintenance of the required particle size in the case of dispersion and by the use of surfactants.
  • Prolonged absorption of injectable compositions can be brought about by including in the composition an agent that delays absorption, for example, monostearate salts and gelatin.
  • a protease binding protein can be administered by a variety of methods, although for many applications, the preferred route/mode of administration is intravenous injection or infusion.
  • the protease binding protein can be administered by intravenous infusion at a rate of less than 30, 20, 10, 5, or 1 mg/min to reach a dose of about 1 to 100 mg/m 2 or 7 to 25 mg/m 2 .
  • the route and/or mode of administration will vary depending upon the desired results.
  • the active compound may be prepared with a carrier that will protect the compound against rapid release, such as a controlled release formulation, including implants, and microencapsulated delivery systems.
  • Biodegradable, biocompatible polymers can be used, such as ethylene vinyl acetate, polyanhydrides, polyglycolic acid, collagen, polyorthoesters, and polylactic acid. Many methods for the preparation of such formulations are available. See, e.g., Sustained and Controlled Release Drug Delivery Systems, J.R. Robinson, ed., 1978, Marcel Dekker, Inc., New York.
  • compositions can be administered with medical devices.
  • a pharmaceutical composition disclosed herein can be administered with a device, e.g., a needleless hypodermic injection device, a pump, or implant.
  • a protease binding protein can be formulated to ensure proper distribution in vivo.
  • the blood-brain barrier excludes many highly hydrophilic compounds.
  • the therapeutic compounds disclosed herein cross the BBB (if desired) they can be formulated, for example, in liposomes.
  • liposomes For methods of manufacturing liposomes, see, e.g., U.S. Patent Nos. 4,522,811; 5,374,548; and 5,399,331.
  • the liposomes may comprise one or more moieties that are selectively transported into specific cells or organs, thus enhance targeted drug delivery (see, e.g., V.V. Ranade, 1989, /. Clin. Pharmacol. 29:685).
  • Dosage regimens are adjusted to provide the optimum desired response (e.g., a therapeutic response). For example, a single bolus may be administered, several divided doses may be administered over time or the dose may be proportionally reduced or increased as indicated by the exigencies of the therapeutic situation. It is especially advantageous to formulate parenteral compositions in dosage unit form for ease of administration and uniformity of dosage.
  • Dosage unit form as used herein refers to physically discrete units suited as unitary dosages for the subjects to be treated; each unit contains a predetermined quantity of active compound calculated to produce the desired therapeutic effect in association with the required pharmaceutical carrier.
  • the specification for the dosage unit forms can be dictated by and directly dependent on (a) the unique characteristics of the active compound and the particular therapeutic effect to be achieved, and (b) the limitations inherent in the art of compounding such an active compound for the treatment of sensitivity in individuals.
  • An exemplary, non-limiting range for a therapeutically or prophylactically effective amount of a protease binding protein disclosed herein is 0.1-20 mg/kg, more preferably 1-10 mg/kg.
  • a protease binding protein can be administered, e.g., by intravenous infusion, e.g., at a rate of less than 30, 20, 10, 5, or 1 mg/min to reach a dose of about 1 to 100 mg/m 2 or about 5 to 30 mg/m 2 .
  • appropriate amounts can be proportionally less. Dosage values may vary with the type and severity of the condition to be alleviated. For a particular subject, specific dosage regimens can be adjusted over time according to the individual need and the professional judgment of the person administering or supervising the administration of the compositions.
  • compositions disclosed herein may include a "therapeutically effective amount” or a “prophylactically effective amount” of a protease inhibitor such as a MMP binding protein disclosed herein.
  • a protease binding protein described herein can be provided as a pharmaceutical composition, e.g., including a pharmaceutically acceptable carrier.
  • the composition can be at least 10, 20, 30, 50, 75, 85, 90, 95, 98, 99, or 99.9% free of other protein species.
  • the binding protein can be produced under GMP (good manufacturing practices).
  • the protease binding protein is provided in pharmaceutically acceptable carriers, e.g., suitable buffers or excipients.
  • the dose of a protease binding protein is sufficient to block about 20%, about 30%, about 40%, about 50%, about 60%, about 70%, about 80%, about 85%, about 90%, about 95%, about 99%, or about 100% of the activity of MMP in the patient, e.g., at the site of disease.
  • this may require a dose, e.g., of between about 0.01 mg/Kg to about 100 mg/Kg, e.g., between about 0.1 and about 10 mg/Kg.
  • the dose can be a dose of about 0.1, about 1, about 3, about 6, or about 10 mg/Kg.
  • these doses correspond to approximately 18 nM, 180 nM, 540 nM, 1.08 microM, and 1.8 microM, respectively, of binding sites for a 5 L blood volume.
  • the optimal dose will be established by clinical trials, but will most likely lie in this range.
  • protease binding proteins especially MMP binding proteins described and identified by the methods described herein and/or detailed herein (or protein-drug conjugates thereof) have therapeutic and prophylactic utilities, particularly in human subjects. These protease binding proteins are administered to a subject to treat, prevent, and/or diagnose inflammatory disorders. Treating includes administering an amount effective to alleviate, relieve, alter, remedy, ameliorate, improve or affect the disorder, the symptoms of the disorder or the predisposition toward the disorder. The treatment may also delay onset, e.g., prevent onset, or prevent deterioration of a disease or condition.
  • Exemplary inflammatory disorders include, but are not limited to, asthma, alopecia greata, systemic lupus erythematosus, rheumatoid arthritis, reactive arthritis, spondylarthritis, systemic vasculitis, insulin dependent diabetes mellitus, multiple sclerosis, experimental allergic encephalomyelitis, Sjogren's syndrome, graft versus host disease, inflammatory bowel disease including Crohn's disease, ulcerative colitis, ischemia reperfusion injury, myocardial infarction, Alzheimer's disease, transplant rejection (allogeneic and xenogeneic), thermal trauma, any immune complex-induced inflammation, glomerulonephritis, myasthenia gravis, cerebral lupus, Guillain-Barre syndrome, vasculitis, systemic sclerosis, anaphlaxis, catheter reactions, atheroma, infertility, thyroiditis, ARDS, post-bypass syndrome, hemodialysis, juvenile rheum
  • an amount of a protease binding protein effective to prevent an inflammatory disorder, or a prophylactically effective amount of the binding agent refers to an amount of a target binding agent, e.g., a kallikrein inhibitor, a plasmin inhibitor, cathepsin B inhibitor, an MMP (e.g., MMP-14, -12, -9, -9/2) binding protein (or MMP binding protein-drug conjugate), e.g., an anti- MT- MMP (e.g., anti-MMP-14) antibody (or anti-MT-MMP antibody-drug conjugate)described herein, which is effective, upon single- or multiple-dose administration to the subject, for preventing or delaying the occurrence of the onset or recurrence of a disorder, e.g., a disorder described herein.
  • a target binding agent e.g., a kallikrein inhibitor, a plasmin inhibitor, cathepsin B inhibitor, an MMP (e.
  • a protease binding protein described herein can be used to reduce an inflammatory disorder in a subject, e.g., to treat rheumatoid arthritis.
  • the method includes administering the binding agent to the subject, e.g., in an amount effective to modulate inflammation, a symptom of the disorder, or progression of the disorder.
  • the protease binding protein e.g., a kallikrein inhibitor, a plasmin inhibitor, cathepsin B inhibitor, an MMP (e.g., MMP-14, -12, -9, -9/2) binding protein (or MMP binding protein-drug conjugate), e.g., an anti-MMP (e.g., anti- MMP-14, -12, -9, -9/2) antibody (or anti- MMP antibody-drug conjugate)) may be administered multiple times (e.g., at least two, three, five, or ten times) before a therapeutically effective amount is attained.
  • protease binding proteins or protease binding protein-drug conjugates, and other agents are also described in "Pharmaceutical Compositions.” Suitable dosages of the molecules used can depend on the age and weight of the subject and the particular drug used.
  • the protease binding proteins or protein-drug conjugates thereof) can be used as competitive agents to inhibit, reduce an undesirable interaction, e.g., between a natural or pathological agent and the protease (e.g., MMP-14).
  • the dose of the protease (e.g., MMP-14) binding protein, or protease binding protein-drug conjugate can be the amount sufficient to block 90%, 95%, 99%, or 99.9% of the activity of protease (e.g., MMP-14) in the patient, especially at the site of disease. Depending on the disease, this may require 0.1, 1.0, 3.0, 6.0, or 10.0 mg/Kg.
  • these doses correspond to approximately 18 nM, 180 nM, 540 nM, 1.08 ⁇ M, and 1.8 ⁇ M of binding sites for a 5 L blood volume.
  • the protease e.g., plasmin, kallikrein, cathepsin B, MMP-14, -12, -9, -9/2 binding proteins, or protease binding protein-drug conjugates
  • an activity e.g., inhibit at least one activity of, reduce proliferation, migration, growth or viability
  • the protease binding proteins can be used by themselves or conjugated to an agent, e.g., a cytotoxic drug, cytotoxin enzyme, or radioisotope.
  • This method includes: administering the protease binding protein alone or attached to an agent (e.g., a cytotoxic drug), to a subject requiring such treatment.
  • an agent e.g., a cytotoxic drug
  • MMP e.g., MMP-14, -12, -9, -9/2 binding proteins that do not substantially inhibit MMP (e.g., MMP-14, -12, -9, -9/2) may be used to deliver nanoparticles containing agents to MMP (e.g., MMP-14, -12, -9, -9/2) associated cells or tissues, e.g., joint tissue.
  • MMP binding proteins can be conjugated to a drug (to form a MMP binding protein-drug conjugate) and deliver the drug to the MMP associated cells or tissues.
  • protease binding proteins bind to cells in the vicinity of the inflamed tissue, but are sufficiently close to the tissue to directly or indirectly inhibit (e.g., inhibit at least one activity, reduce growth and proliferation, or kill) the inflammation.
  • the protease binding proteins may be used to deliver an agent (e.g., any of a variety of therapeutic drugs) to cells and tissues where the MMP (e.g., MMP-14, -12, -9, -9/2) is present.
  • agent e.g., any of a variety of therapeutic drugs
  • MMP e.g., MMP-14, -12, -9, -9/2
  • agents include DMARDs, BRMs, immunosuppressive agents, etc.
  • protease e.g., kallikrein, plasmin, cathepsin B, MMP-14, -12, -9, - 9/2 binding proteins, or MMP binding protein-drug conjugates.
  • protease e.g., kallikrein, plasmin, cathepsin B, MMP-14, -12, -9, - 9/2 binding proteins, or MMP binding protein-drug conjugates.
  • Suitable dosages of the molecules used will depend on the age and weight of the subject and the particular drug used.
  • the binding proteins can be used as competitive agents to inhibit or reduce an undesirable interaction, e.g., between a natural or pathological agent and the protease.
  • Diseases to be treated include rheumatoid arthritis, psoriasis, multiple sclerosis, systemic sclerosis, asthma, chronic obstructive pulmonary disease, inflammatory bowel disease (e.g., Crohn's and Ulcerative Colitis).
  • RA Rheumatoid arthritis
  • RA is an autoimmune, chronic inflammatory disease that causes joint swelling and pain and normally results in joint destruction.
  • RA generally follows a relapsing/remitting course, with "flares" of disease activity interspersed with remissions of disease symptoms.
  • RA is associated with a number of additional inflammatory disorders, including Sjogren's syndrome (dry eyes and mouth caused by inflammation of tear and saliva glands), pleuritis (inflammation of the pleura that causes pain upon deep breath and coughing), rheumatoid nodules (nodular sites of inflammation that develop within the lungs), pericarditis (inflammation of the pericardium that causes pain when lying down or leaning forward), Felty syndrome (splenomegaly and leucopenia observed in conjunction with RA, making the subject prone to infection), and vasculitis (an inflammation of the blood vessels which can block blood flow).
  • Sjogren's syndrome dry eyes and mouth caused by inflammation of tear and saliva glands
  • pleuritis inflammation of the pleura that causes pain upon deep breath and coughing
  • rheumatoid nodules nodular sites of inflammation that develop within the lungs
  • pericarditis inflammation of the pericardium that causes pain when lying down
  • Symptoms of active RA include fatigue, lack of appetite, low grade fever, muscle and joint aches, and stiffness. Muscle and joint stiffness are usually most notable in the morning and after periods of inactivity. During flares, joints frequently become red, swollen, painful, and tender, generally as a consequence of synovitis.
  • Treatment for rheumatoid arthritis involves a combination of medications, rest, joint strengthening exercises, and joint protection.
  • Two classes of medications are used in treating rheumatoid arthritis: anti-inflammatory "first-line drugs," and “Disease-Modifying Antirheumatic Drugs” (DMARDs).
  • the first-line drugs include NSAIDS (e.g., aspirin, naproxen, ibuprofen, and etodolac) and cortisone (corticosteroids).
  • DMARDS such as gold (e.g., gold salts, gold thioglucose , gold thiomalate, oral gold), methotrexate, sulfasalazine, D-penicillamine, azathioprine, cyclophosphamide, chlorambucil, and cyclosporine, leflunomide, etanercept, infliximab, anakinra, and adalimumab, and hydroxychloroquine, promote disease remission and prevent progressive joint destruction, but they are not anti-inflammatory agents.
  • gold e.g., gold salts, gold thioglucose , gold thiomalate, oral gold
  • methotrexate e.g., methotrexate
  • sulfasalazine D-penicillamine
  • azathioprine azathioprine
  • cyclophosphamide chlorambucil
  • the disclosure provides methods of treating (e.g., ameliorating, stabilizing, or eliminating one or more symptoms or ameliorating or stabilizing the subject's score on a RA scale) rheumatoid arthritis by administering a therapeutically effective amount of a protease binding protein such as a kallikrein-, plasmin-, cathepsin B-, or MMP- binding protein, particularly an MMP (e.g., MMP-14, -12, -9, -9/2) binding protein in combination with another therapeutic agent such as a DMARD, BRM, corticosteroid, or NSAID, or protease binding protein-drug conjugate (e.g., with one of the aforementioned therapeutic agents), to a subject having or suspected of having RA.
  • a protease binding protein such as a kallikrein-, plasmin-, cathepsin B-, or MMP- binding protein
  • MMP e.g., MMP-14, -12, -9,
  • the disclosure provides methods preventing rheumatoid arthritis by administering a therapeutically effective amount of a protease binding proteins such as a kallikrein-, plasmin-, cathepsin B-, or MMP- binding protein, particularly an MMP (e.g., MMP-14, -12, -9, -9/2) binding protein in combination with another therapeutic agent such as a DMARD, BRM, corticosteroid, or NSAID, or protease binding protein- drug conjugate (e.g., with one of the aforementioned therapeutic agents), to a subject at risk of having RA.
  • a protease binding proteins such as a kallikrein-, plasmin-, cathepsin B-, or MMP- binding protein, particularly an MMP (e.g., MMP-14, -12, -9, -9/2) binding protein in combination with another therapeutic agent such as a DMARD, BRM, corticosteroid, or NSAID, or protea
  • rheumatoid arthritis associated disorder e.g., Sjogren's syndrome, pleuritis, pulmonary rheumatoid nodules, pericarditis, Felty syndrome, or vasculitis
  • a protease binding protein such as a MMP binding protein, particularly a MMP binding protein in combination with another therapeutic agent such as a DMARD, BRM, corticosteroid, or NSAID, or MMP binding protein-drug conjugate (such as with one of the aforementioned therapeutic agents).
  • a rheumatoid arthritis associated disorder e.g., Sjogren's syndrome, pleuritis, pulmonary rheumatoid nodules, pericarditis, Felty syndrome, or vasculitis
  • a protease binding protein such as a MMP binding protein, particularly a MMP binding protein in combination with another therapeutic agent such as a DMARD, BRM, corticosteroid, or NSAID, or MMP binding protein-drug conjugate (such as with one of the aforementioned therapeutic agents).
  • RASS Rheumatoid Arthritis Severity Scale
  • ASHI Arthritis Specific Health Index
  • AIMS Arthritis Impact Measurement Scales or Arthritis Impact Measurement Scales 2
  • HAQ Stanford Health Assessment Questionnaire
  • HAQII HAQII
  • modified HAQ see, e.g., Pincus et al. (1983) Arthritis Rheum. 26(11): 1346-53).
  • Guidance for the determination of the dosage that delivers a therapeutically effective amount of an agent or combination of agents may be obtained from animal models of rheumatoid arthritis, such as collagen-induced arthritis (CIA), which is induced, typically in rodents, by immunization with autologous or heterologous type II collagen in adjuvant (Williams et al. Methods MoI Med. 98:207-16 (2004)).
  • CIA collagen-induced arthritis
  • COPD Chronic Obstructive Pulmonary Disease
  • COAD chronic obstructive airway disease
  • COPD chronic obstructive airway disease
  • COPD is a group of diseases characterized by the pathological limitation of airflow in the airway that is not fully reversible.
  • COPD is the umbrella term for chronic bronchitis, emphysema and a range of other lung disorders. It is most often due to tobacco smoking, but can be due to other airborne irritants such as coal dust, asbestos or solvents, as well as congenital conditions such as alpha- 1 -antitrypsin deficiency.
  • COPD cerebrospinal fluid
  • dyspnea shortness of breath
  • wheezing wheezing
  • a persistent cough with sputum production It is possible the sputum may contain blood (hemoptysis) and become thicker, usually due to damage of the blood vessels of the airways. Severe COPD could lead to cyanosis caused by a lack of oxygen in the blood. In extreme cases it could lead to cor pulmonale due to the extra work required by the heart to get blood to flow through the lungs.
  • COPD is particularly characterised by the spirometric measurement of a ratio of forced expiratory volume over 1 second (FEVi) to forced vital capacity (FVC) being ⁇ 0.7 and the FEVi ⁇ 80% of the predicted value as measured by a plethysmograph.
  • Other signs include a rapid breathing rate (tachypnea) and a wheezing sound heard through a stethoscope.
  • Pulmonary emphysema is NOT the same as subcutaneous emphysema, which is a collection of air under the skin that may be detected by the crepitus sounds produced on palpation.
  • Treatment for COPD includes inhalers that dilate the airways (bronchodilators) and sometimes theophylline.
  • the COPD patient must stop smoking.
  • inhaled steroids are used to suppress lung inflammation, and, in severe cases or flare-ups, intravenous or oral steroids are given.
  • Antibiotics are used during flare-ups of symptoms as infections can worsen COPD.
  • Chronic, low-flow oxygen, non-invasive ventilation, or intubation may be needed in some cases.
  • Surgery to remove parts of the disease lung has been shown to be helpful for some patients with COPD.
  • Lung rehabilitation programs may help some patients. Lung transplant is sometimes performed for severe cases.
  • ⁇ 2 agonists include: Salbutamol (Ventolin), Bambuterol, Clenbuterol, Fenoterol, and Formoterol, and long acting ⁇ 2 agonists (LABAs) such as Salmeterol.
  • M 3 muscarinic antagonists include the quaternary M 3 muscarinic antagonist Ipratropium, which is widely prescribed with the ⁇ 2 agonist salbutamol, Ipratropium, and Tiotropium, which can be combined with a LABA and inhaled steroid.
  • Cromones include Cromoglicate and Nedocromil.
  • Leukotriene antagonists can be used and include Montelukast, Pranlukast, and Zafirlukast.
  • Xanthines include theophylline, methylxanthines, theobromine. More aggressive EMR interventions include IV Hi antihistamines and IV dexamethasone.
  • Phosphodiesterase-4 antagonists inlcude roflumilast and cilomilast can be used and include glucocorticoids, beclomethasone, mometasone, and fluticasone. Corticosteroids are often combined with bronchodilators in a single inhaler. Salmeterol and fluticasone can be combined (Advair). TNF antagonists include cachexin, cachectin infliximab, adalimumab and etanercept.
  • the disclosure provides methods of treating (e.g., ameliorating, stabilizing, or eliminating one or more symptoms of or ameliorating COPD by administering a therapeutically effective amount of a protease binding protein such as a kallikrein, plasmin, cathepsin B, or MMP binding protein, particularly a MMP binding protein in combination with COPD treatment (e.g., ⁇ 2 agonists, M 3 antimuscarinics, leukotriene antagonists, cromones, corticosteroids, and xanthines) or protease binding protein-drug conjugate (such as with one of the aforementioned COPD treatments), to a subject having or suspected of having COPD.
  • a protease binding protein such as a kallikrein, plasmin, cathepsin B, or MMP binding protein
  • MMP binding protein particularly a MMP binding protein in combination with COPD treatment
  • COPD treatment e.g., ⁇ 2 agonists, M 3 antimuscarin
  • the disclosure provides methods preventing COPD by administering therapeutically effective amount of a protease binding protein such as a kallikrein-, plasmin-, cathepsin B-, or MMP- binding protein, particularly a MMP (e.g., MMP-14, -12, -9, -9/2) binding protein in combination with COPD treatment (e.g., ⁇ 2 agonists, M 3 antimuscarinics, leukotriene antagonists, cromones, corticosteroids, and xanthines) or protease binding protein-drug conjugate (such as with one of the aforementioned COPD treatments), to a subject at risk of having COPD.
  • COPD treatment e.g., ⁇ 2 agonists, M 3 antimuscarinics, leukotriene antagonists, cromones, corticosteroids, and xanthines
  • protease binding protein-drug conjugate such as with one of the aforementioned COPD treatments
  • Asthma is a chronic condition involving the respiratory system in which the airway occasionally constricts, becomes inflamed, and is lined with excessive amounts of mucus, often in response to one or more triggers. These episodes may be triggered by such things as exposure to an environmental stimulant (or allergen) such as cold air, warm air, moist air, exercise or exertion, or emotional stress. In children, the most common triggers are viral illnesses such as those that cause the common cold. This airway narrowing causes symptoms such as wheezing, shortness of breath, chest tightness, and coughing. The airway constriction responds to bronchodilators.
  • asthma is characterized by chronic respiratory impairment. In others it is an intermittent illness marked by episodic symptoms that may result from a number of triggering events, including upper respiratory infection, stress, airborne allergens, air pollutants (such as smoke or traffic fumes), or exercise. Some or all of the following symptoms may be present in those with asthma: dyspnea, wheezing, stridor, coughing, an inability for physical exertion. Some asthmatics who have severe shortness of breath and tightening of the lungs never wheeze or have stridor and their symptoms may be confused with a COPD-type disease.
  • asthma attack An acute exacerbation of asthma is commonly referred to as an asthma attack.
  • the clinical hallmarks of an attack are shortness of breath (dyspnea) and either wheezing or stridor.
  • asthma is the result of an immune response in the bronchial airways.
  • Relief medication Short-acting, selective beta 2 -adrenoceptor agonists, such as salbutamol (albuterol USAN), levalbuterol, terbutaline and bitolterol, can be used. Older, less selective adrenergic agonists, such as inhaled epinephrine and ephedrine tablets, can be used. Anticholinergic medications, such as ipratropium bromide may be used.
  • Preventative medication Current treatment protocols recommend prevention medications such as an inhaled corticosteroid, which helps to suppress inflammation and reduces the swelling of the lining of the airways, in anyone who has frequent (greater than twice a week) need of relievers or who has severe symptoms. If symptoms persist, additional preventive drugs are added until the asthma is controlled. With the proper use of prevention drugs, asthmatics can avoid the complications that result from overuse of relief medications.
  • prevention medications such as an inhaled corticosteroid, which helps to suppress inflammation and reduces the swelling of the lining of the airways, in anyone who has frequent (greater than twice a week) need of relievers or who has severe symptoms. If symptoms persist, additional preventive drugs are added until the asthma is controlled. With the proper use of prevention drugs, asthmatics can avoid the complications that result from overuse of relief medications.
  • Preventive agents include: inhaled glucocorticoids (e.g., ciclesonide, beclomethasone, budesonide, flunisolide, fluticasone, mometasone, and triamcinolone), leukotriene modifiers (e.g., montelukast, zafirlukast, pranlukast, and zileuton), mast cell stabilizers (e.g., cromoglicate (cromolyn), and nedocromil), antimuscarinics/anticholinergics (e.g., ipratropium, oxitropium, and tiotropium), methylxanthines (e.g., theophylline and aminophylline), antihistamines, an IgE blocker such as omalizumab, methotrexate).
  • inhaled glucocorticoids e.g., ciclesonide, beclomethasone, bude
  • Beta 2 -adrenoceptor agonists can be used and include salmeterol, formoterol, bambuterol, and sustained-release oral albuterol. Combinations of inhaled steroids and long-acting bronchodilators are becoming more widespread; the most common combination currently in use is fluticasone/salmeterol (Advair in the United States, and Seretide in the United Kingdom). Another combination is budesonide/formoterol which is commercially known as Symbicort.
  • the disclosure provides methods of treating (e.g., ameliorating, stabilizing, or eliminating one or more symptoms of or ameliorating asthma by administering a therapeutically effective amount of a protease binding protein combination with asthma treatment (e.g., glucocorticoids, leukotriene modifiers, mast cell stabilizers, antimuscarinics/anticholinergics, antihistamines, an IgE blocker, methotrexate) or protease binding protein-drug conjugate (such as with one of the aforementioned asthma treatments), to a subject having or suspected of having asthma.
  • a protease binding protein combination with asthma treatment e.g., glucocorticoids, leukotriene modifiers, mast cell stabilizers, antimuscarinics/anticholinergics, antihistamines, an IgE blocker, methotrexate
  • protease binding protein-drug conjugate such as with one of the aforementioned asthma treatments
  • the disclosure provides methods preventing asthma by administering a therapeutically effective amount of a protease binding protein combination with asthma treatment (e.g., glucocorticoids, leukotriene modifiers, mast cell stabilizers, antimuscarinics/anticholinergics, antihistamines, an IgE blocker, methotrexate) or protease binding protein-drug conjugate (such as with one of the aforementioned asthma treatments), to a subject at risk of having asthma.
  • asthma treatment e.g., glucocorticoids, leukotriene modifiers, mast cell stabilizers, antimuscarinics/anticholinergics, antihistamines, an IgE blocker, methotrexate
  • protease binding protein-drug conjugate such as with one of the aforementioned asthma treatments
  • MS Multiple sclerosis
  • CNS central nervous system
  • MS presents with a variety of symptoms, including changes in sensation (hypoesthesia); muscle weakness, abnormal muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems in speech (dysarthria) or swallowing (dysphagia); visual problems (nystagmus, optic neuritis, or diplopia); fatigue and acute or chronic pain syndromes; and bladder and bowel difficulties.
  • Cognitive impairment of varying degrees, or emotional symptomatology in the form of depression or pseudobulbar affect are also common. Neuropathic pain is usual, and this can be in the form of Lhermitte's sign.
  • Paraesthesias can be present and include pins and needles; tingling; shivering; burning pains; feelings of pressure; and areas of skin with heightened sensitivity to touch.
  • the pains associated with these can be aching, throbbing, stabbing, shooting, gnawing, tingling, tightness and numbness.
  • the main clinical measure of disability progression and severity of the symptoms is the Expanded Disability Status Scale or EDSS.
  • the initial attacks are often transient, mild (or asymptomatic), and self-limited.
  • the common initial symptoms reported are: changes in sensation in the arms, legs or face (33%), complete or partial vision loss (optic neuritis) (16%), weakness (13%), double vision (7%), unsteadiness when walking (5%), and balance problems (3%); but many rare initial symptoms have been reported such as aphasia or psychosis. Optic neuritis or focal leg weakness may lead to falls and other serious accidents.
  • Several therapies have proven helpful for treatment of multiple sclerosis.
  • the aims of treatment include returning function after an attack, preventing new attacks, and preventing disability.
  • administration of high doses of intravenous corticosteroids, such as methylprednisolone is the routine therapy for acute relapses.
  • Disease-modifying treatments including interferons (e.g., AVONEX®, REBIF®, BETAFERON®), glatiramer acetate (e.g., COPAXONE®), immunosuppressant (e.g., mitoxantrone) and natalizumab (e.g., TYSABRI®) are used for relapsing- remitting MS.
  • interferons e.g., AVONEX®, REBIF®, BETAFERON®
  • glatiramer acetate e.g., COPAXONE®
  • immunosuppressant e.g., mitoxantrone
  • phagocytic macrophages are MMP-12 positive, suggesting a role for MMP-12 during demyelination in MS (Vos et al. J Neuroimmunol 2003: 138(1- 2): 106).
  • the disclosure provides methods of treating (e.g., ameliorating, stabilizing, or eliminating one or more symptoms of or ameliorating MS by administering a therapeutically effective amount of a protease binding protein in combination with MS treatment (e.g., interferons (e.g., AVONEX®, REBIF®, BETAFERON®), glatiramer acetate (e.g., COPAXONE®), immunosuppressant (e.g., mitoxantrone) and natalizumab (e.g., TYSABRI®)) or protease binding protein-drug conjugate (such as with one of the aforementioned MS treatments), to a subject having or suspected of having MS.
  • MS treatment e.g., interferons (e.g., AVONEX®, REBIF®, BETAFERON®), glatiramer acetate (e.g., COPAXONE®), immunosuppressant (e.g., mitoxantrone
  • Treatment for some of the symptoms of scleroderma includes drugs that soften the skin and reduce inflammation.
  • Topical treatment for the skin changes of scleroderma do not alter the disease course, but may improve pain and ulceration.
  • a range of NSAIDs nonsteroidal anti-inflammatory drugs
  • NSAIDs nonsteroidal anti-inflammatory drugs
  • the skin tightness may be treated systemically with methotrexate and cyclosporin.
  • the disclosure provides methods of treating (e.g., ameliorating, stabilizing, or eliminating one or more symptoms of or ameliorating SSc by administering a therapeutically effective amount of a protease binding protein in combination with SSc treatment (e.g., NSAIDs, calcium channel blockers, prostacyclin analogue, the dual endothelin-receptor antagonist, methotrexate, cyclosporin, ACE inhibitors, cyclophosphamide, epoprostenol, and bosentan) or protease binding protein-drug conjugate (such as with one of the aforementioned SSc treatments), to a subject having or suspected of having SSc.
  • SSc treatment e.g., NSAIDs, calcium channel blockers, prostacyclin analogue, the dual endothelin-receptor antagonist, methotrexate, cyclosporin, ACE inhibitors, cyclophosphamide, epoprostenol, and bosentan
  • IBD Inflammatory bowel disease
  • IBD is a group of serious, chronic relapsing inflammatory diseases affecting both the small and large intestine, which remains relatively resistant to current treatments. IBD is characterized by spontaneously occurring, chronic relapsing inflammation of unknown origin, in which current treatment options are inadequate. Despite extensive research into the disease in both humans and experimental animals, the precise mechanisms of pathology remain to be elucidated. A host of immune and inflammatory mediators are thought to be involved, including biogenic amines, kinins, arachidonic acid metabolites, free radicals, nitric oxide, various proinflammatory cytokines, and complement proteins.
  • IBD Crohn's Disease and ulcerative colitis including ulcerative proctitis, ulcerative proctosigmoiditis, lymphocytic colitis, intractable distal colitis, ileocolitis, collagenous colitis, microscopic colitis, pouchitis, radiation colitis, and antibiotic-associated colitis.
  • IBD may require immunosuppression to control the symptom, such as prednisone, infliximab (REMICADE®), azathioprine (IMURAN®), methotrexate, or 6-mercaptopurine. More commonly, treatment of IBD requires a form of mesalamine. Often, steroids are used to control disease flares and were once acceptable as a maintenance drug. In use for several years in Crohn's disease patients and recently in patients with ulcerative colitis, biologicals have been used such as the intravenously administered REMICADE®. Severe cases may require surgery, such as bowel resection, strictureplasty or a temporary or permanent colostomy or ileostomy. Alternative medicine treatments for bowel disease exist in various forms, however such methods concentrate on controlling underlying pathology in order to avoid prolonged steroidal exposure or surgical excisement
  • the disclosure provides methods of treating (e.g., ameliorating, stabilizing, or eliminating one or more symptoms of or ameliorating IBD by administering a therapeutically effective amount of a protease binding protein in combination with IBD treatment (e.g., immunosuppresants, anti-TNF binding proteins, cytokine inhibitors, BRMs, antiinflammatories, etc.) or protease binding protein- drug conjugate (such as with one of the aforementioned IBD treatments), to a subject having or suspected of having IBD.
  • IBD treatment e.g., immunosuppresants, anti-TNF binding proteins, cytokine inhibitors, BRMs, antiinflammatories, etc.
  • protease binding protein- drug conjugate such as with one of the aforementioned IBD treatments
  • Psoriasis is a well known condition which affects the skin of affected patients.
  • the disease manifests itself as chronic, recurring silvery papules, scaling papules and plaques of various sizes.
  • the condition may consist of one or two lesions or may be a widespread dermatosis with disabling arthritis or exfoliation.
  • Psoriasis presents as elevated lesions that vary in size between one to several centimeters.
  • Psoriasis is one of the most common dermatologic diseases, affecting about 2 percent of the population to some degree. There are actually several types of psoriasis, with plaque psoriasis being the most common, but the underlying problem in all of them is overproduction of epidermal cells. Instead of adhering to the 21 to 28 day cycle of cell turnover, those afflicted with psoriasis race through the cycle in 3 or 4 days.
  • the epidermis may grow to 5 to 10 times its normal thickness.
  • the thickened epidermis, overgrowth of blood vessels, and infiltrate of neutrophils and lymphocytes account for the psoriatic lesions being raised and easily palpable. The lesions may range from a few to many at any given time.
  • Medications with the least potential for adverse reactions are preferentially employed. If the treatment goal is not achieved then therapies with greater potential toxicity may be used. Medications with significant toxicity are reserved for severe unresponsive psoriasis.
  • medicated ointments or creams called topical treatments, are applied to the skin. If topical treatment fails to achieve the desired goal then the next step would be to expose the skin to ultraviolet (UV) radiation. This type of treatment is called phototherapy.
  • UV radiation ultraviolet
  • the third step involves the use of medications which are taken internally by pill or injection. This approach is called systemic treatment.
  • Bath solutions and moisturizers help soothe affected skin and reduce the dryness which accompanies the build-up of skin on psoriatic plaques.
  • Medicated creams and ointments applied directly to psoriatic plaques can help reduce inflammation, remove built-up scale, reduce skin turn over, and clear affected skin of plaques.
  • Ointment and creams containing coal tar, dithranol (anthralin), corticosteroids like desoximetasone (Topicort), vitamin D3 analogues (for example, calcipotriol), and retinoids are routinely used.
  • Argan oil has also been used with some promising results. The mechanism of action of each is probably different but they all help to normalise skin cell production and reduce inflammation.
  • Activated vitamin D and its analogues are highly effective inhibitors of skin cell proliferation.
  • UV light contains many different wavelengths of light. It was during the early part of the 20th century that it was recognised that for psoriasis the therapeutic property of sunlight was due to the wavelengths classified as ultraviolet (UV) light.
  • UVA 380-315 nm
  • UVB 315-280 nm
  • UVC ⁇ 280 nm
  • UVB Ultraviolet B
  • Narrowband UVB (311 to 312 nm), is that part of the UVB spectrum that is most helpful for psoriasis. Exposure to UVB several times per week, over several weeks can help people attain a remission from psoriasis.
  • Ultraviolet light treatment is frequently combined with topical (coal tar, calcipotriol) or systemic treatment (retinoids) as there is a synergy in their combination.
  • topical coal tar, calcipotriol
  • systemic treatment retinoids
  • the Ingram regime involves UVB and the application of anthralin paste.
  • the Goeckerman regime combines coal tar ointment with UVB.
  • immunomodulator drugs are approved for the treatment of moderate to severe cases of psoriasis. They include alefacept (AMEVIVE®), efalizumab (RAPTIV A®), etanercept (ENBREL®) and infliximab (REMICADE®). These drugs are given by intravenous infusion, intramuscular injection or subcutaneous injection and are usually used for people who have failed to respond to traditional therapy or for people with associated psoriatic arthritis. Biologies work by blocking interactions between certain immune system cells. They have strong effects on the immune system and likely pose many of the same risks as other immunosuppressant drugs.
  • the disclosure provides methods of treating (e.g., ameliorating, stabilizing, or eliminating one or more symptoms of or ameliorating psoriasis by administering a therapeutically effective amount of a protease binding protein in combination with psoriasis treatment (e.g., immunosuppresants, retinoids, immunomodulator (biologies) drugs, etc.) or protease binding protein-drug conjugate (such as with one of the aforementioned psoriasis treatments), to a subject having or suspected of having psoriasis.
  • psoriasis treatment e.g., immunosuppresants, retinoids, immunomodulator (biologies) drugs, etc.
  • protease binding protein-drug conjugate such as with one of the aforementioned psoriasis treatments
  • the disclosure provides methods of preventing psoriasis by administering a therapeutically effective amount of a protease binding protein in combination with psoriasis treatment (e.g., immunosuppresants, retinoids, immunomodulator (biologies) drugs, etc.) or protease binding protein- drug conjugate (such as with one of the aforementioned psoriasis treatments), to a subject at risk of having psoriasis.
  • psoriasis treatment e.g., immunosuppresants, retinoids, immunomodulator (biologies) drugs, etc.
  • protease binding protein- drug conjugate such as with one of the aforementioned psoriasis treatments
  • the agents or therapies can be administered at the same time (e.g., as a single formulation that is administered to a patient or as two separate formulations administered concurrently) or sequentially in any order. Sequential administrations are administrations that are given at different times. The time between administration of the one agent and another agent can be minutes, hours, days, or weeks.
  • the use of a protease binding protein described herein can also be used to reduce the dosage of another therapy, e.g., to reduce the side-effects associated with another agent that is being administered, e.g., to reduce the side-effects of an immunosuppressive agent. Accordingly, a combination can include administering a second agent at a dosage at least 10, 20, 30, or 50% lower than would be used in the absence of the protease binding protein.
  • the second agent is a DMARD such as methotrexate, Leflunomide, Sulphasalazine, Gold — parenteral (Myocrisin), Gold — oral (auranofin), antimalarials such as Hydroxychloroquine, Chloroquine phosphate, Chloroquine sulphate, antibiotics such as Minocycline, D-Penicillamine, Azathioprine, Cyclophosphamide, Cyclosporine, Leflunomide/ Arava, TNF- ⁇ inhibitors/anti-TNF agents such as Etanercept (Enbrel®), Adalimumab (Humira®), and Infliximab (Remicade®).
  • a DMARD may be considered as a member of one of the other classes of drugs above or below, if that drug or agent has immunosuppressive activity or is a BRM.
  • the second agent is a BRM such as a TNF- ⁇ inhibitor (Etanercept (ENBREL®), Adalimumab (HUMIRA®), and Infliximab (REMICADE®)), a CTLA4-Ig (Abatacept (ORENCIA®)) or anti-CD20 (RITUXAN®), any monoclonal antibody, interferon, interleukin-2, various types of colony-stimulating factors (CSF, GM-CSF, G-CSF), and Kineret (anakinra, IL-I antagonist).
  • a BRM such as a TNF- ⁇ inhibitor (Etanercept (ENBREL®), Adalimumab (HUMIRA®), and Infliximab (REMICADE®)
  • CTLA4-Ig Abatacept (ORENCIA®)
  • anti-CD20 RITUXAN®
  • any monoclonal antibody any monoclonal antibody
  • interferon interleukin-2
  • the second agent is an NSAID such as aspirin, naproxen, ibuprofen, etodolac, or salsalte.
  • the second agent is a corticosteroid.
  • Second agents for use in treating other inflammatory disorders such as COPD, asthma, MS, systemic sclerosis, inflammatory bowel disease and psoriasis in such combination treatments are described above.

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Abstract

L'invention concerne des procédés et des compositions qui utilisent des protéines de liaison de protéase en combinaison avec d'autres agents thérapeutiques pour traiter des troubles inflammatoires tels que l'arthrite rhumatoïde, le psoriasis, la sclérose en plaques, la sclérose généralisée, l'asthme, une maladie pulmonaire obstructive chronique, une maladie intestinale inflammatoire (par exemple la colite de Crohn et la colite ulcéreuse). L'utilisation de la protéine de liaison de protéase permet d'utiliser une plus petite dose des autres agents thérapeutiques dans les procédés et compositions, de sorte que les effets secondaires des autres agents thérapeutiques sont réduits ou éliminés.
EP09822726A 2008-10-22 2009-10-22 Polythérapie comportant des protéines de liaison de protéase pour des troubles inflammatoires Withdrawn EP2350305A4 (fr)

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CA2741492A1 (fr) 2010-04-29
JP2013533206A (ja) 2013-08-22

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